2018-2020 Flashcards
(305 cards)
1
Q
How many g of Na is recommended per day?
A
Age 1-4: 1500
Age 5+: 2300
2
Q
Name 4 health risks of climate change
A
Heat and cold related morbidity and mortality
Natural hazards and extreme weather events
Increasing air pollution
Contaminated water sources
Infection risks associated with insects, ticks, and rodents
Stratospheric ozone depletion (worse up North with thinner ozone layer)
3
Q
Why are children at higher risk of climate related health effects?
A
They have longer life time exposure and metabolize more per kilo
4
Q
What children are at higher risk for climate related health risks?
A
Low SES
Indigineous
Chronic disease
5
Q
What health concerns occurs occur in natural health hazards and weather events?
A
Injury and death Displaced from home Overcrowding Mental health impacts Food or water shortage Interruption to health care and education
6
Q
What health complications occur due to ozone layer depletion?
A
Increased UV exposure
More skin cancer and cataracts and immune system compromise
7
Q
How can pediatricians prevent climate change health complications?
A
Advocate for government to act against climate change
Volunteer on disaster planning committees
Recommending trainee climate change teaching
Role model environmental sustainability
8
Q
5 ways to approach vaccine hesitancy in the community
A
Detect and address vaccine hesitant group
Educate health care providers on immunization best practices
Evidence based strategies to improve uptake
Educate children, youth, and adults on importance of immunization
Work collaboratively
9
Q
Name 4 EBM strategies to increase vaccine uptake
A
Target underimmunized groups Make vaccine services convenient and accessible Engage community leaders (religious etc) Remind patients by text, mail, etc. Ensure uniformity across Canada Minimize pain Mandates or incentivized vaccines Build trust in immunization program
10
Q
How to approach vaccine hesitancy in your clinic?
A
Don’t discharge anti vaccer from clinic
Presumptive approach and motivational interviewing
Effective clear language to explain vaccines
Manage immunization pain
Reinforce importance in community protection
11
Q
Do you need neuropsych or psychology assessment to diagnose ADHD?
A
No
Only if complex ADHD with comorbidities or hard to diagnose
12
Q
How should you manage suspecting ADHD in toddlers?
A
Parents should go to parenting class to teach them developmentally appropriate expectations of toddlers
13
Q
Risk factors for ADHD (4)
A
Family history Epilepsy Hypoxic ischemic brain injury Traumatic brain injury In utero alcohol or tobacco exposure Low birth weight Intellectual disability Autism Prematurity (inattentive type only) Environmental toxins Central auditory processing d/o Fragile X Turner syndrome 22q11 Tuberous sclerosis NF1
14
Q
Adverse outcomes of ADHD (4)
A
Poor education outcomes Poor relationships More MVA More accidental injuries More substance abuse
15
Q
Do stimulants worsen tics?
A
Sometimes better and sometimes worse and sometimes no change. Don’t stop meds just change dose.
16
Q
Ways to help diagnose ADHD (4)
A
Questionnaires
Mutliple clinic visits
Evaluate for comorbid d/o
Review report cards
Neurological and dysmorphology physical exam
Full history including prenatal
Ask about attachment, temperament, regulation
17
Q
What makes ADHD more likely to persist into adulthood? (3)
A
Inattentive/hyperactive combined
More severe
Comorbid depression
More than 3 DSM d/o
Parental anxiety
Parental antisocial personality disorder
Intellectual disorder (also decreased med response especially when IQ under 50)
18
Q
DSM V Criteria (5)
A
- Symptoms are severe and persistent since under 12 years old and for more than 6 mo
- Symptoms impair daily functioning in some way
- Need to have a reason for why there is discrepancy in symptoms in different settings
- Specify type ( inattentive, hyperactive, or both)
- Severity defined by degree of impairment
19
Q
What are inattentive ADHD symptoms? (5)
A
Lack of detail focus Easily distracted Lose objects Forgetful Difficulty organizing tasks Cannot follow instructions Difficulty keeping attention Hard time listening
20
Q
What are hyperactive ADHD symptoms? (5)
A
Leaves seat often Blurts out answers Fidgeting Running around or restless Lour or noisy Always on the go Excessive talking Cannot wait their turn Acting without thinking
21
Q
What is first line med in youth with ADHD (after non pharmacological therapy)
A
MPH or dexamphetamine extended release
22
Q
What is the condition that can develop if guanficine or clonidine are stopped quickly?
A
Hypertension or hypertensive encephalopathy
23
Q
Name non pharmacological ADHD therapies (6)
A
Psychoeducation (educate parents) Shared decision making with family Parental behaviour training Classroom behaviour management Daily report card Behavioural peer interventions Organizational skills training Social skills training Cognitive training Exercise
24
Q
Benefits of stimulants (3)
A
Improved academics Better parental reported QOL Less risky behaviour Less MVA Less anxiety and depression later on Better job
25
Side effects of stimulants and non stimulant ADHD meds? (3 each)
```
Stimulants:
Appetite loss
Behaviour changes
Poor sleep
Raynaud's
Priapism
Up to 2.5 cm shorter
```
Non stimulants:
Liver toxicity
Hypotension
26
Side effects of stimulants and non stimulant ADHD meds? (3 each)
```
Stimulants:
Appetite loss
Behaviour changes
Poor sleep
Raynaud's
Priapism
```
Non stimulants:
Liver toxicity
Hypotension
27
How often should you increase a stimulant dose?
Every 1-4 weeks
28
What are risk factors for poor med compliance I'm ADHD?
Older age
Learning disorder
Mood disorder
Beahvioural comorbidities
29
What side effect do ASD patients see in stimulants for ADHD?
More stereotyped behaviour and iutbursts
30
3 risk factors for TB
Indigineous
Poor ventilation
Overcrowding
Foreign born in TB endemic region
31
BCH vaccine contraindication?
Immunodeficiency
32
How long after exposure to contact case does primary infection normally develop
Within 1 year
33
What percent of TB infections are asymptomatic?
90-95%
34
Who is at highest risk of early primary TB disease?
Children under 4 years old
35
What are two triggers for reactivation of TB?
Puberty
Immunocompromisation
Malnutrition
Steroid exposure
36
Name 5 disseminated regions for TB
```
Meningitis
Disseminated (hematogenous spread and multi system)
Lymphadenitis
Osteomyelitis
Peritonitis
Liver or spleen granuloma
```
37
2 radiographic findings of early primary TB
Ground glass opacities
| Hilar or mediastinal lymphadenopathy
38
1 disseminated disease CXR finding
Miliary nodules
ARDS pattern
Pleural effusion a
Cavitary lesions (usually upper lung field)
39
What is gold standard to diagnose primary or reactivated TB?
Cultures with stain, PCR, and sensitivity testing from sputum, gastric aspirate, bronchoscopy
40
What other infectious disease must you test for in all patients with TB?
HIV
41
What is TST positive size? And what are the causes of false positives or negatives?
Greater than 5 mm if immunocompromised
Greater than 10 mm in others
False positive if there is non TB mycobacterium exposure (1% of those with BCG vaccine will have false positive TST after age 10)
False negative if immunosuppressed or malnourished
42
In children older than 2 is IGRA or TST more specific?
| In children less than 2 is IGRA or TST more sensitive?
Over 2 IGRA more specific
| Under 2 TST more sensitive
43
Causes of false positives or negatives in IGRA
False positives: almost none
False negatives: immunocompromised
Better is children with BCG vaccine because more specific
44
How long must a culture positive patient with TB isolate for?
Either 2 weeks of therapy if initial sputum smear negative OR
3 negative sputum smear negative
45
If a child has a positive contact with index case if TB what investigations and treatment should be done?
History and physical
CXR
TST
Get index case drug sensitivity
Treat children under 5 with negative TST (under 5 mm) with single drug prophylaxis until negative TST done 8-10 weeks from last contact exposure
Treat children with TST over 5 mm as having latent infection
Don't treat children over 5 with initial negative TST but repeat TST at 8-10 weeks from last contact exposure
46
What drugs do you use to treat latent TB?
Isoniazid
Rifampin
Rifapebtin or isoniazid
47
What is first line contraceptive for Canadian youth.
LARC
48
What are 2nd tier and 3rd tier contraceptive options?
2nd: hormonal contraceptives
3rd: barriers, withdrawal, spermicide
49
4 absolute contraindications to estrogen containing contraceptives?
```
Migraine with aura
Severe liver disease
Severe HTN
Active breast CA
Serious immobility after surgery
History of clots
```
50
How much greater is the stroke or VTE risk on OCP?
VTE 2-4x
| Stroke 1.5-2x
51
What is the only contraceptive option that causes weight gain?
Depo Provera
52
What do you need on exam before starting OCP?
BP and weight
53
What is a quick start contraceptive method?
If not first 7 days past LMP get bHCG
Start contraception same day
Repeat bHCG in 21 days
54
How long post coitus can a copper IUD be inserted for emergency contraception?
7 days
55
Who should get HPV vaccine?
All kids age 9-13 and any older children as catch up
56
How many doses of HPV vaccine are recommended and how far apart?
2 doses 6 months apart
| 3 doses if immunocompromised or if older than 14
57
What is the disorder infants can have is HPV is transmitted from mother at time of delivery?
Juvenile onset recurrent respiratory papillomatosis
58
Which strain of HPV causes cancer? Causes warts commonly?
CA: 16 and 18
Warts: 6 and 11
59
What are risk factors for HPV (3)
```
More lifetime sexual partners
STIs
Sexual abuse
Young age of first sexual contact
Tobacco or marijuana use
Immunosuppression
HIV
MSM
```
60
Is HPV vaccine associated with GBS?
No
61
When should you discuss potential G tube insertion with a family?
When neurologic impairment is first diagnosed
Poor oral intake and weight gain
Feeding difficulties
GERD causing poor oral intake
Dysmotility despite medical treatment
Enteral feeding for >3-6 months is anticipated
62
What are 3 short term risks of G-tube feeding?
```
Peritonitis
Bleeding
Infection
Anesthesia related problems
Abdominal organ puncture
Perioperative death
```
63
What are 3 long term risks of G-tube feeding?
```
Blockage
Dislodgement
Breakage
Stoma infection
Stoma bleeding
Stoma skin irritation
```
64
3 categories of concerns to address when counselling around G-tube placement
Child topics: benefits and complications, plan for oral feeding or stimulation, socialization plan
Parent topics: meaning of feeding, logistics (finances, etc.), parent self-care, goals of care
Family topics: potential impact on siblings, anticipated reaction of extended family
65
Name 4 benefits to having a G-tube
```
Better nutrition
Less hospitilization
Less antibiotics
Less chest infections
Less feeding time
Less caregiver feeding concerns
Increased QOL for caregiver
Ease of medication delivery
```
66
2 most common organisms causing osteoarticular infections?
```
S.aureus
K.kingae (common in infants)
S.pneumoniae
S. pyogenes
S. agalactiea
Salmonella (in sickle cell patients)
H.flu (if not vaccinated)
```
67
What is the empiric antibiotic used in osteoarticular infections? What if the child is under 4 or unimmunized?
```
IV cefazolin
IV cefuroxime (because if covers H.flu)
```
68
What is the most sensitive and specific noninvasive test for acute osteomyelitis?
MRI with gad (still always need a baseline radiograph)
69
When can you switch from IV to PO therapy for acute osteomyelitis?
Clinical improvement (mild intermittent pain)
Inflammatory markers have started to normalize (CRP decreased by 50% in last 4 days or <20-30)(ESR is less reliable and decreases slowly)
Reliable oral outpatient follow up
Negative blood culture
Weight bearing or able to move affected limb
70
What is the most common bony location for osteomyelitis?
Metaphysis of the long bones
71
What is the typical age range for transient synovitis?
Age 4-10
72
How long after contracting Lyme disease do you expect to see Lyme arthritis develop in infected patient?
2-12 months
73
What skin finding is associated with CRMO? What time is CRMO pain worse?
Worse at night
Associated with psoriasis and palmoplantar pustulosis
Usually occurs in unusual places (jaw, scapula)
74
How long after a GI or GU infection do you expect to see reactive arthritis?
2-3 weeks later
75
What is a Brodie's abscess?
Necrotic bone surrounded by new bone in region with chronic osteomyelitis for more than 4 weeks
76
Do you need follow up radiographs after osteomyelitis is treated? What if there is growth plate involvement
No. If growth plate is involved there is need for orthopedic follow up.
77
When you step down to PO antibiotics in osteomyelitis what do you use if the patient is MRSA positive?
TMP SMX, linezolid, clindamycin
78
What are two very important tests in S.aureus bacteremia?
```
MRI bone (looking for osteomyelitis)
Echo (S.aureus is sticky and often becomes endocarditis even if seeded elsewhere first)
```
79
What is the duration of treatment for osteomyeltis or septic arthritis?
3-4 weeks (as long as CRP norma)
| 4-6 weeks if hip involved (as long as CRP normal)
80
Most common age to get ITP?
Age 2-5
81
What percetage of ITP cases self resolve by 6 months?
75-80%
82
What are 3 secondary causes of ITP?
```
Drug induced
Lupus
Infections
Immune deficiencies
Malignancy
```
83
What are 5 red flags for alternate diagnosis for ITP?
```
Constitutional symptoms
Bone pain
Recurrent thrombocytopenia
Poor treatment response
Lymphadenopathy
Hepatomegaly
Splenomegaly
Signs of chronic disease
Low hemoglobin
High MCV
Abnormal WBC
Abnormal smear or morphology on smear
```
84
What classifies as mild bleeding in ITP? What are your treatment options in mild ITP?
Criteria: no bleeding, small non-ozzing petechiae on mucosa, mild resolved epistaxis, or bruising
Treatment: Observe (consider steroid or IVIG)
85
What are 2 recommendations to families just observing with conservative management of ITP?
No NSAIDs
| No physical activity risking injury
86
What classifies as moderate bleeding in ITP? What are your treatment options in moderate ITP?
Criteria: troublesome epistaxis or menorrhagia, severe skin or mucosal lesions
Treatment: steroid (prednisone 4mg/kg/day divided BID for 4 days and taper or 2 mg/k/day once daily for 1-2 weeks) OR IVIG (1g/kg)
87
What classifies as severe bleeding in ITP? What are your treatment options in severe ITP?
Criteria: prolonged epistaxis or menorrhagia, melena, ICH, hospital admission required for bleeding
Treatment: methylprednisolone AND IVIG (1g/kg) AND platelet transfusion AND tranexamic acid (25 mg/kg/dose 3-4 times a day)
88
How do you manage ITP relapse or non-response?
In relapse use the same criteria as before to decide to treat.
In non-response try other (ie. steroid or IVIG) that was not yet trialed
89
What are disadvantages of using steroids in ITP management?
```
Mood change
Increased weight/appetite
Gastritis
Hypertension
Poor taste limits tolerance
```
90
What are disadvantages of using IVIG in ITP management?
```
Aseptic meningitis
Nausea/vomiting
Fever
Rash
Hemolysis
Risks of IV placement and hospital admission
```
91
How long after giving steroids do platelets normally increase in ITP? How about after steroids?
After steroids it takes 48 h to increase.
| After IVIG it takes 24 hours to respond (peak at 2-7 days)
92
What are the 4 Ms of healthy screen use in school aged children and adolescents?
Manage screen use
- make family media plan
- discourage media multitasking
- be present and engaged for media use
- use parental controls and privacy settings
Meaningful screen use
- prioritize routines and physical activity over screens
- focus on educational, active, or social media use
- developmentally appropriate content
Model healthy screen use
Monitor for signs of problematic screen use
- boredom without screen access
- oppositional behaviour
- interference of screens with school, play, etc.
93
3 benefits of appropriate screen time use in school aged children
Can improve academics, literacy, etc.
Help develop peer or teacher relationships
Video games with others encourage socialization, identity and cognitive development
Lower depression (with 1 hr day recreational screen time)
More inclusive relationships
94
3 risks of screen time use in school aged children
Age inappropriate or violent contact can negatively effect development/behaviour
>3 hr TV/day = increased conduct problems
High recreational screen time increases depression
Less quality material available to low income families
Less family or social interactions if high screen time
Multitasking causes worse academics
95
What is the recommended amount of screen time in adolescents daily?
2-4 hours a day
96
3 benefits of screen time in adolescents
Improved self concept
Social media is validating and allow "bounce back" from social rejection
Improved psychosocial function and emotions (if 2-4 hr/day)
Improved socialization for physically isolated children or those with less social support
97
3 risks of screen time in adolescents
Negative content (bullying) can cause anxiety and depression
More depression if over 6 hours/day
Lower scores in school with media multitasking
>50% of free time on games causes worse conduct, well-being, hyperactivity, and peer problems
Too much time can impact family closeness and relationships
98
3 negative impacts of screen time on the physical health of youth
Can decrease physical activity
TV viewing linked with decreased fruits/veggies and increased weight
Screens in bedrooms worsen sleep hygiene
Texting while driving
Headaches and vision concerns if there is too much screen use
99
3 positive impacts of screen time on the physical health of youth
Some promote physical activity
Health tracking with weight, diet, etc. can encourage healthy habits
Active video games are positive in short term
100
How old is a child before they are no longer referred to as having a global developmental delay and instead an intellectual delay?
Age 5
101
GDD diagnostic criteria
Significant delay (at least 2 SDS below mean) in at least 2 of the following:
- gross or fine motor
- speech/language
- cognition
- social/personal
- ADLs
102
ID diagnostic criteria (3)
Meet all 3 of the following:
- defects in intellectual functions (planning, problem solving, academic learning)
- defects in adaptive functions (not able to be independent or socially responsible)
- onset of both of the above during developmental period
103
Categories and causes of intellectual disability or GDD. (4 categories (1 example of each))
```
Prenatal intrinsic
- genetic, metabolic, CNS malformation
Prenatal extrinsic
- toxin, infections
Perinatal
- asphyxia, prematurity, neonatal complications
Postnatal
- neglect, infection, trauma
```
104
What two exams should all patients with intellectual and GDD receive in their initial work up? (2)
Audiology
Ophthalmology
EEG (if suspected seizures)
105
What should you do for 1st investigations if a child has ID or GDD with unknown cause? (4)
Chromosomal microarray
Fragile X testing
Tier 1 investigations
Brain MRI is abnormal neuro exam or micro/macrocephaly
MECP2 in girls (moderate to severe symptoms)
106
What are the Tier 1 metabolic investigations for ID/GDD NYD? (7)
CBC, glucose, gas, BUN/Cr, lytes, AST/ALT, TSH, CK, ammonia, lactate, amino acids, acytlcarnitine, carnitine, homocysteine, copper, ceruloplasmin, biotinidase, ferritin (when diet restriction of PICA), vitamin B12 (when diet restriction of PICA), lead level (when risk factors), urine organic acids, urine creatine metabolites, urine purines/pyrimidines, urine GAGs
107
If there is no cause of IDD or GD on first tier testing what are your next steps? (2)
Neurology referral
Genetics/metabolics referral (for tier 2 work up and gene panels)
Brain MRI (if not done)
108
When should you do autism screnning?
Regular well child or health visits, with thorough assessment at 18 months
Earlier if: sibling with ASD, health care provider or parental or caregiver concern
109
What are the DSM V diagnostic criteria for autism?
Symptoms in two domains
1) Social communication impairment
2) Restricted, repetitive pattern of behaviour/interests
3) Signs and symptoms present early in development
4) Interferes with everyday life
5) Symptoms not better explained by intellectual disability or GDD
110
4 examples of symptoms of social communication impairment in the DSM V autism diagnosis
1) Difficulty initiating or responding to social interactions
2) Reduced spontaneous sharing of interests
3) Reduced eye contact
4) Less gestures
5) Reduced facial expressiveness
6) Use someone's hand to get an object
7) Less interest in peers
8) Not engaging in imaginative play
111
4 examples of symptoms of repetitive and restrictive behaviours/interests in the DSM V autism diagnosis
1) Repeated words or phrases
2) Repetitive activity with objects
3) Repetitive body movements
4) Transient stiff posturing
5) Wearing same clothes/eating same foods
6) Distress with routine change
7) Restricted interests
8) Hypo or hypersensitive
112
Risk factors of ASD (3)
```
Male
Family history
Sibling with ASD
Certain genetic syndromes
Parents over 35
Maternal obesity, diabetes, or HTN
In utero valproate, pesticide, or traffic pollution exposure
Maternal rubella
Pregnancy less than 12 month apart
Low birth weight
Extreme prematurity
```
113
Common red flags for ASD at age 6-12 months (3)
```
Reduced smiling
Limited eye contact
Limited reciprocal sound or facial expression sharing
Diminished babbling or gesturing
Limited response to name
```
114
Common red flags for ASD at age 9-12 months (1)
Repetitive behaviours
| Unusual play
115
Common red flags for ASD at age 12-18 months (2)
No single words
No pointing
Lack of pretend play
Limited joint attention
116
Common red flags for ASD at age 15-24 months (1)
No two word phrases
117
Name two developmental screening tests that assess for general development and two for ASD specifically (4)
Generic: ASQ-3, Child Development Inventory, Nipissing District Developmental Screen, Brief Early Childhood Screening Assessment, Parents' Evaluation of Developmental Status, Rourke Baby Record
ASD Specific: M-CHAT, Infant Toddler Checklist, Social Responsiveness Scale, Autism Spectrum Rating Scales, STAT, RITA-T
118
If the general developmental screen is concerning for ASD what should the next step be? If the next step is positive?
ASD specific rating scale
then....
Diagnostic assessment
119
Who can do the diagnostic assessment for ASD? While they are waiting for the assessment what referral should be immediately sent?
Pediatrician
Specialized team
Psychologist + pediatrician
They should see an early intervention service before diagnosis
120
Name two ways to make easier clinic visit for patients with ASD
Call family first to conduct first portion of visit virtually
Consider inviting family for a practice visit
First or last appointment of the day
Longer appointment slot
Parents bring comfort items
Rearrange room for sensory sensitivities
121
Common disorders to screen for or plan to manage in ASD (4)
Dental concerns (challenging and may need sedation)
Nutrition (need dietitian assessment)
GI issues (constipation, GERD, celiac) more common
Sleep disorders in 50-80%
Anxiety in 50%
ADHD in 30-50%
Depression (in older high functioning kids)
122
What are 2 behavioural interventions for ASD patients?
Early intensive behavioural therapy
Parent mediated interventions
Social skills training
CBT (for anxiety)
123
3 common triggers for worsening in ASD challenging behaviour
```
Physical environment
Change in routine
Puberty/developmental change
Bullying
Pain or physical ailment that cannot be communicated
Communication frustration
Social over stimulation
```
124
What are two common medication options to treat ASD aggression, self harm, or irritability when non-pharmacological therapy is not successful?
Risperidone
| Aripiprazole
125
3 side effects of atypical anti-psychotics?
```
Extrapyramidal symptoms
Drowsiness
Metabolic syndrome
Weight gain
Prolactinemia
```
126
What are a few non-harmful complimentary medicine options for ASD (2)
```
Vitamin supplementation
Dietary changes
Massage
Music therapy
Animal therapy
Therapeutic touch
Reki
```
127
What is a harmful complimentary medicine option for ASD?
```
Hyperbaric oxygen
Secretin
Chelation
Herbal products
Antifungals
Antibiotics
```
Cannibidiol oil (unclear if harmful but not recommended)
128
2 factors that provide better prognosis for ASD?
Early identification
Timely access to behavioural interventions
Higher cognitive ability
129
How many hours before most major cardiorespiratory problems present in newborns?
6-12 h after birth
130
3 important topics to cover in healthy newborn parental discharge education
```
Infant feeding
Newborn behaviour and and care
Recognition of early signs of illness
Infant safety (car seat, safe sleep)
Infection control measures
Smoke free environment importance
Fever, sepsis, and when to go to hospital
```
131
3 important topics to cover in healthy newborn parental discharge education
```
Infant feeding
Newborn behaviour and and care
Recognition of early signs of illness
Infant safety (car seat, safe sleep)
Infection control measures
Smoke free environment importance
Fever, sepsis, and when to go to hospital
```
132
3 investigations or treatments all infants should have before discharge home.
```
NBS
Hearing screen
Bili and 24h
Pulse ox screen
Vaccines if needed
Follow up arranged
Vitamin K
Ophthalmia neonatorum prophylaxis if regionally appropriate
```
133
When should healthy newborns follow up with a health care provider after birth?
Within first week of life unless discharged less than 48 from broth then it should occur by 72 hr of life
134
What should an infant have done prior to discharge? (3)
Fed with mother at least 2 times successfully
Passed urine
Passed meconium
135
What should a physician ensure they have done on history or exam for info prior to discharge of a newborn?
Documented normal vitals
Weight, length, and head circumference
Physical exam
Assessment of psychosocial qnd environmental concerns
Reviewed maternal serology
Assessed antenatal and prenatal risk factors (GBS risk factors, etc.)
Ensure no more than 10% birth weight loss
Ensure breastfeeding mothers are giving vitamin D supplementation
136
In a returning traveller what are 4 investigations you should do and 2 to consider?
Must: CBC, liver enzymes, lytes, Cr, malaria smears, blood cultures, urinalysis +/- urine culture
Consider: stool culture(salmonella, shigella, camylobater, yersinia, e.coli), CXR, stool ova and parasites(cyclosora, cryptosporidium, entamoe bahistolytica), viral serology
137
What are the 3 most important travel related causes of fever in returning travellers?
Malaria (within 6 mo of return)
Travellers diarrhea and enteric fever (within 60 days of return)
Dengue (within 14 days of return)
138
3 risk factors for contacting infections while travelling
Incomplete vaccination
Immuncompromised
Low weight or nutritional status
Very young age (under 1 month)
139
What is the treatment for pinworm?
Albendazole
140
What is the type of malaria with highest mortality rate?
Plasmodium falciparum
141
What are the stages in the biphasic response to typhoid?
1. Gastroenteritis and diarrhea
| 2. Hepatomegaly, thrombocytopenia, leukopenia, fever, myalgias, psych or neuro symptoms
142
What is the common cause if travellers diarrhea if onset less than 2 weeks after exposure? What if it has onset greater than 2 weeks after exposure?
1. Rotavirus or bacterial infection
| 2. Post infectious diarrhea or giardiasis
143
What is the classic rash in dengue fever?
Erythematous and reticulate over thorax, face, and flexion areas
144
What are 2 biochemical findings in repeat dengue fever or hemorrhagic dengue?
```
Hyponatremia
Hypoproteinemia
Lymphocytosis
Neutropenia
Elevated liver enzymes
```
Present in circulatory shock
145
What are is the cause and time of onset of each of the following types of hemorrhagic disease of the newborn?
Early onset, classic, late onset
Early onset: 24 hours of life due to maternal meds
Classic: day 2-7 due to low intake of vitamin k
Late onset: 2-12 weeks and up to 6 months due to malabsorption and low intake
146
What is the dose of IM vitamin K in a newborn?
O.5 to 1 mg
| In prems: 0.5 mg if under 1500g and 1 mg is over 1500g
147
What is the dose of PO dose of vitamin K
2 mg within 6 hr of birth and then at 2-4 wk of age and 6-8 wk of age.
148
1st line treatment of lice infections
Premethrin (1%) or pyrethrin
149
What is 2nd line treatment for lice
Isopropyl myristate (Resultz) age 4+
Dimeticone age 2+
Benzyl alcohol 5% age 6mo+
150
Is the presence of nits on the head diagnostic of a lice infection?
No. Nits are dead. You need at least 1 live louse to diagnose.
151
How many times and how far apart must premethrin doses be when treating lice?
2 doses 7 days apart
152
Do kids with lice need to stay home from school?
No
153
What are the percent of HIV positive mother's that go on to have vertical transmission in Canada?
2%
154
Risk factors for HIV vertical transmissions (4)
```
IV drug use
Late or no prenatal care
Recent illness and HIV seroconversion
Regular unprotected sex with HIV positive partner STIs in pregnancy
Emigration fr HIV endemic area
```
155
What should be done for HIV if a mother presents in labour with no HIV? What if she is unknown and only can be tested after delivery? What is mother refuses testing?
1. Rapid HIV testing on mother
2. Rapid HIV testing on mother
3. Rapid infant antibody testing
156
What should be done if mother or infant rapid HIV antibody testing comes back positive? (2)
Send confirmatory antibody testing
Infant HIV PCR within 48 hr of birth
Start prophylaxis before 72 hr post delivery
No breastfeeding
157
What should be done if infant HIV PCR comes back positive?
Stop prophylaxis
| Start antiretroviral therapy
158
What should you do of there is strong suspicion for HIV infection acutely in pregnancy or while breastfeeding but negative antibodies?
Send maternal PCR since antibodies may not yet be positive.
159
What are CBC findings seen on infants exposed to antiretroviral therapy for HIV?
Anemia
| Neutropenia
160
If an infant has a mother with confirmed HIV in pregnancy what 2 things should you do when they are born?
Consult ID
| Send for HIV PCR
161
If a mother has negative HIV testing early in pregnancy but is at high risk of HIV exposure in pregnancy when should you repeat the test?
3rd trimester before 36 weeks
162
What are the benefits of cooling infants on term infants that meet criteria?
Decreased mortality
| Decreased moderate to severe neurodevelopmental delay
163
What are the criteria for cooling an infant with HIE?
Over 36 weeks and with moderate-severe HIE who are under 6 hr life and meet A or B
A. Cord oH under 7 and base deficit more than -16
B. pH 7.01-7.15 or base deficit -10 to -15.9 AND history of acute perinatal event AND APGAR under 5 at 10 min
164
What are 4 side effects of hypothermia
```
Bradycardia
Hypotension
Thrombocytopenia
PPHN
SCF
```
165
What is the optimal temperature for cooling infants with HIE?
33-34
166
How long should cooling for HIE last for?
72 hr
167
Why don't we cool pre infants with HIE
Increased mortality
168
What happens to medication metabolism when an infant is cooled for HIE?
Slows down so less drug clearance and lower doses may be needed
169
4 complications of HIE?
```
CP
Blindness
Behavioural difficulties
Seizures
Cognitive deficits
SNHL
```
170
Which immunodeficiencies can receive most lvyie vaccines? Which can receive only live viral vaccines?
1. IgA deficiency, IgG subclass deficiency, complement deficiencies, anatomical or functional asplenia, HIV without severe immunocompromise
2. Phagocyte or neutrophil disorders
171
How long before someone is going to be immunocompromise can you give live and inactive vaccines?
Live - 4 weeks
| Inactive - 2 weeks
172
How long after stopping high dose steroids, immunosuppressive chemo, or anti B cell antibody can a live vaccine be given?
High dose steroids: 1 month
Chemo: 3 months
Anti B cell therapy: 6 months
173
How long after getting a bone marrow transplant can you get a live or inactive vaccine? How long after giving a bone marrow transplant?
1. Live: 24 months, inactive: 3-12 mo
| 2. 4 weeks
174
How long after getting a solid organ transplant can you get a live or inactive vaccine? How long after giving a solid organ transplant?
1. Never live. 3-6 mo for an inactive vaccine
| 2. 4 weeks
175
How long after receiving IVIG or specific immunoglobulin should you wait before vaccines?
3-11 months for live vaccines
| Immediately for inactive or oral or intranasal live vaccines
176
What are 5 ways to improve pediatric medication safety and access in Canada?
1. Establish a pediatric advisory board to regulate, reimburse, and research pediatric medications
2. Health Canada can solicit and review peds med data and work on setting pediatric standards and benchmarks for regulation and reimbursement
3. Health Canada can promote priority pediatric medications and child friendly formulations and review SAP program
4. National resource on pediatric prescribing and dosing
5. Invest in pediatric drug research and infrastructure.
177
5 problems with pediatric meds in Canada
1. Health Canada does not look for peds data when regulating meds even if available
2. Most meds are off label
3. Not peds friendly formulations and co m pounding increases risk and decreases consistency
4. More rare disease so meds more expensive
5. Dependency on SAP for essential meds
178
4 risk factors for invasive group A strep
```
HIV
Cancer
Heart disease
Diabetes
Lung disease
Alcohol abuse
Injection drug use
Postpartum period
Recent pharyngitis
Varicella
Recent soft tissue trauma
NSAID use
```
179
What is the definition of invasive group A strep?
Isolation of group A strep fo a sterile site with or without clinical evidence of severe invasive disease.
180
4 presentations of severe invasive GAS
TSS
Soft tissue (muscle, fat, etc.) necrosis
Meningitis
Pneumonia (only if pleural effusions)
181
TSS diagnostic criteria
Hypotension and at least 2 of the following
- renal impairment (Cr x 2 upper limit)
- coagulopathy (plt under 100 or DIC)
- liver function abnormality (enzymes over 2x upper limit)
- ARDS
- macular erythmatic rash that can desquamate
- other life threatening condition
182
4 clinical signs of nec fasc
```
Severe pain
Rapid progression
Hemodynamic instability
Toxic appearance
Woody induration
Hyperesthesia or anesthesia
Crepitus if polymicrobial
```
183
What is the antibiotic therapy for suspected and confirmed invasive GAS?
Suspected: Beta lactam + beta lactamase inhibitor (piptazo, clox)
Clinadamycin (only for 48 hr)
+/- vanco is possible MRSA
Confirmed: penicillin and clinadamycin
Consider IVIG for 1 day in either
184
What med should not be given in invasive group a strep?
NSAID
185
What would count as a close contact of someone with invasive group A strep?
Household contact with 20 h total or 4 h/day in last 7 day
Anyone sharing a bed or sexual relations
Direct contact with mucous membrane or oral and nasal secretions
IVD user sharing needles
Family or child home care children and staff
186
Who gets post exposure invasive GAS prophylaxis?
Close contacts
| Children in daycare with multiple cases within a month or during concurrent varicella out break
187
What is first line chemoprophylaxis and time it is given for invasive group a strep? Second line?
Cephalexin within 24 hr of detection
Second line if not tolerated is clarithromycin or clinadamycin
188
Why are RSV and rotavirus easy to transmit in a pediatric office?
Low infective dose and remains on inanimate objects for a prolonged period
189
What are 3 easily transmissible infections in pediatric offices through stethoscope diaphragms, blood pressure cuffs, and thermometer bases?
```
MRSA
VRE
Rotavirus
RSV
C diff
```
190
What precautions for patients for hep A and how long should they be taken?
Contact. 7 days since onset of symptoms
191
For measles how long should airborne precautions be used?
4 days from rash onset.
192
What is TB infectious? (3)
```
Untreated cavitary lesion
Laryngeal disease
Smear positive sputum
Extensive lung involvement
Disseminated congenital infection
```
193
5 ways to reduce infection spread in outpatient office
Have policy on hygiene and review ever 2 yr
Have hand washing station in every space
No carpets
Patients that are immunocompromised or with infectious symptoms (particularly travel in last 21 days) should be in room not waiting room
Space patient times out to limit exposure
Remove toys from waiting room
Clean mouse and keyboard daily
Disposable paper to be used in between patients
Avoid multidose medication vial
Staff should be vaccinated and regular TB screening
194
4 times for hand hygiene in pediatric office
```
After contact with patient
Before contact with patient
After secretion contact
Before procedures
After handling live vaccine
After touching contaminated surfaces
After and before touching sterile meds
After removing gloves
```
195
What is the best measure of iron stores?
Ferritin - but these are inaccurate if there is inflammation
196
What are the two types of non anemic iron deficiency?
Low urine stores (low ferritin)
| Decreased iron transport (low transferrin saturation)
197
4 risk factors for iron deficiency under 2 years old
```
Preterm or LBW (under 2500g)
Low SES
Mother with anemia or obesity
Early umbilical cord clamping
Male
Breastfeeding only over 6 months
High cows milk intake
Prolonged bottle use
Chronic infection
Lead exposure
Low intake of iron rich foods
Indigineous
H.pylori (in older kids)
```
198
How much iron supplementation is recommended preventatively for infants born weighing under 2000g or between 2000-2500g?
2000 g 2-3 mg/kg/day for first year
| 2000-2500g 1-2 mg/kg/day for 6 mo (starting between 2-6 wk of age)
199
What age does health Canada recommend introduction of cow's milk and how much?
9-12 months
| Limit of 750 mL a day
200
How much iron should a normal healthy infant 7-12 months old get in their diet daily?
11 mg/day
201
What is the dose of iron for treatment of IDA and what should be eaten with it to improve absorption?
How long is the minimum therapy?
2-6mg/kg/day
Take with vitamin C source
Minimum 3 months
202
5 symptoms of lead toxicity
```
Headache
Abdo pain
Anemia
Constipation
Vomiting
Clumsiness
Sombolenxe
Stupor
Renal failure
Seizures
Cognitve function impairment
Hyperactivity
Hearing impairment
Speech delay
Inattention
```
203
What part of the body is lead normally stored in? What can trigger its release?
Bones
| Puberty, growing, stress, pregnancy, malnutrition
204
What are 3 common sources of lead?
Water (pipes)!
Food (lead in cans from outside Canada, bullet in wild game, food grown on old industrial sites)
Dust and soil
Mouthing lead containing products
205
What are 4 risk factors for lead exposure that you should test lead levels in if there is also a neurodevelopmental delay?
Friend or sibling with lead poisoning
Pica or eating paint chips
Living in a house built before 1960
Emigrate for adopted from a country with high lead levels
206
What nutritional deficiencies also increase the chance of developing lead intoxication?
Ca, zinc, iron (or maternal deficiencies of these) or other divalent ions
207
What 4 investigations should be done when lead exposure is suspected?
Lead level
Iron level
CBC
Ca, protein, albumin
208
Above what blood lead lead level should it be investigated and lead exposures eliminated?
5mcg/dL
209
Does a low lead level rule out lead intoxication?
No because 1/2 life of RBC is 45 days and lead stored in bone so exposure could have been earlier
210
What are 3 long term consequences if lead exposure?
HTN
Vascular disease
Renal impairment
Aberrant behaviour
211
If blood level is between 5-14 what are 3 steps to take and when do you retest levels
1. Reduxe potential exposures
2. Plan for full neurodevelopmental assessment
3. Contact public health
4. Encourage iron sufficiency with testing levels and encouraging fresh fruit with each meal to add vitamin C and increase iron absorption
Retest levels I'm 1-3 months to ensure not rising
212
What extra steps should be taken for children with lead levels between 15-44 compared to those from 5-15?
Consider abdominal x-ray and if foreign object is found it should be removed
Contact poison control
Repeat levels in 1-4 weeks to confirm it is real
213
What extra management is required for lead levels above 44 compared to power levels? (2)
Repeat levels in 48 hr to confirm result
| Consider hospitalization for chelation
214
What can opioid exposure in utero cause in newborns?
```
Prematurity
Low birth weight
Increased spontaneous abortions
SIDS
Neurobehavioural abnormalities
NAS
```
215
What do NAS symptoms start and how long do they normally last?
Start in 48-72 hr and last 10-30- days
215
What do NAS symptoms start and how long do they normally last?
Start in 48-72 hr (5 days if methadone) and lasts 10-30- days
216
Which infants are at the lowest risk of NAS?
Premature infants
217
What are 5 symptoms of NAS?
```
High pitched cry
Poor sleep
Hyperactive
Tremors
High muscle tone
Myoclonic jerks
Sweating
Hyperthermia
Yawning
Mottling
Sneezing
Nasal flare
Tachypneic
Excessive sucking
Reflux
Loose stools
Poor feeding
```
218
4 non pharmacologic interventions for NAS
```
Skin to skin
Swaddling
Gentle walking
Quiet environment
Minimal stimulation
Lower lighting
Developmental positioning
Music or massage therapy
Breastfeeding
```
219
3 meds that can be used to treat NAS
```
Morphine
Methadone
Phenobarbital
Clonidine
Buprenorphine
```
220
What criteria must be met for MAID?
Over 18
Grevious and irremediable medical condition
Voluntary request
Capable of informed consent
221
What are the recommendations for drug coverage for pediatric patients in Canada?
Universal comprehensive pharmacare for all kids
Need comprehensive list of drugs covered across all of Canada
Pediatric drug approval should be modernized
Government should support pediatric drug trials and research
222
What are 5 ways to make a good rapid response team in a pediatric setting?
```
Criteria for activation of team
Education about clinical deterioration
Standard vitals monitoring on the ward
Quality monitoring process
Expertise and training in pediatrics
Sim based training
Planned response arm
```
223
What are the 3 ps of reducing pediatric pain?
Physical
Psychological
Pharmacological
224
4 physical techniques to reduce pain in procedures?
```
Sitting upright
Distracting words
Family presence
Breastfeeding
Sucrose (0.5-2mL)
Non nutritive sucking
Skin to skin
Swaddling infants
Chose less painful approaches
Reduce and group blood work when possible
```
225
4 psychological techniques to reduce pain during procedures
```
Prepare them
Distraction
Deep breathing
Hypnosis
Music therapy
```
226
Name 3 topical anesthetics that can be used in needle procedures and which has the fastest onset
```
Lidocaine (EMLA)
Liposomal lidocaine (Maxilene)
Ametocaine (Ametop)
Vapocoolant spray (pain ease) * fastest immediate onset
```
(Consider nitrous oxide when not sufficient)
227
What is the biggest side effect of topical lidocaine? What are the other contraindications?
Methemoglobinemia
| G6PD, heart block, severe liver disease
228
What factors increase viral transmission risk with a needle stick injury?
```
Bigger needles
Hollow bore
Blood injected
High concentration of virus in blood
Deeper penetration
```
229
If exposed to a needlestick at risk for HepB transmission what should be done for a child that is anti-HBsAg postivie or or negative or fully vaccinated but unknown anti-HBsAg.
Positive: nothing
Unknown: give HBV vaccine if results are pending for anti-HBsAg more than 48 hr
Negative: test for hep B antibody and antigen and if both negative HBIG and HBV vaccine within 7 day if injury
230
What type of needle stick injury is at risk of HIV transmission
Hollow bore needle with blood in it and injected into body or mouth
When the user has or IV drug user population is known to have high risk of HIV
231
When should a tetanus vaccine or immunoglobulin be given for an injury?
Vaccine: more than 10 years since vaccine or 5-10 years since vaccine and wound is dirty
If: only if greater than 10 years since vaccine and a dirty wound
232
What blood should be done on a child after a needlestick injury?
HBV, HIV, and HCV antibodies and antigens
233
How soon over a needlestick injury should HIV prophylaxis be started if it was high risk?
1-4 h of injury
| No later than 72 hr
234
How long after a needlestick should someone get a repeat HBV vaccine if they were antibody negative?
4 weeks and again 6 mo
235
How long after a needle stick should HBV, HIV, and HVV blood work be done
4-6 wk: anti HIV antibody
3 mo: anti- HIV antibody and anti-HCV antibody
6 mo: anti- HIV antibody and anti-HCV antibody and antiHBsAg antibody
236
What methods can be used to provide neuroprotection in prem infants?
```
Maternal steroid (under 35 wks)
Maternal antibiotics (under 33 weeks)
MgSO4 (under 34 weeks)
Normothermia (under 32 week)
Avoiding inotrope use
Permissive hypercapnia (under 33 wk)
Delayed cord clamp
Volume targeted ventilation
Neutral head position
Decreased transportation and noise
Good nutrition
```
237
When should premature infants have a blood culture drawn and antibiotics started?
Under 33 weeks and chorioamnionitid, preterm labour, PPROM, unexplained onset of nonreassuring fetal status, rupture of membranes more than 72 hr
238
How long before birth should you aim to give steroids to a mother in premature labour?
48 hr
239
What is the definition of hypotension in a newborn infant?
Under 30 mmHg or MAP less than infants GA
240
What does a preterm newborn need to start inotropes on top of hypotension?
Prolonged cap refill
Decreased urine output
Elevated lactate
Echocardiography findings
241
What are the ABCDEs of parent child relationship building?
```
Ask questions
Build on family relational strength
Counsel with family centred guidance
Develop plans for challenging behaviours related to sleep and discipline
Educate about positive parenting
```
242
What are 5 principles to clinicians supporting positive parenting?
```
Help build loving relationships
Accept that there is reasons for all behaviour
Help mitigate effects of ACEs
Recognize and respect differences
Be aware of good family resources
```
243
Name 3 positive parenting strategies when dealing with problematic behaviours
Use I statements
Use time ins (connect and redirect)
Avoid using words like no, stop, don't
Focus on why the behvoiur is occuring and let go of previous events or patterns
Communicate comfort and empathy (kneel down, gentle head nod)
Wait until child and parent are emotionally ready to re-engage
244
What does the REDIRECT acronym stand for in positive parenting?
```
Reduce words
Embrace emotions
Describe without lecturing
Involve the child in discipline
Reframe no to yes
Emphasize the positive
Creatively approach w discipline situation
Teach
```
245
How long does a CD4 count need to be in HIV to be immunocompromised?
Age 5+: less than 200
| Under 5: less than 15%
246
What are 4 immunosuppressive classes of medications?
```
Antimetabolites
Chemotherapeutics
Transplant immunosuppressants
Biologics
High dose corticosteroid +20 mg prednisone daily of over 10kg or 2 mg/kg/day of under 10kg
```
247
What are 5 ways to reduce respiratory or water borne infection in immunocompromised kids?
```
Vaccinate them and family
Good hand hygiene
Avoid anyone with resp illness and crowded locations in viral season
Avoid tobacco smoke exposure
Avoid exposure to fungi
Drink tap water
Avoid hot tubs
Avoid swimming on contaminated water
```
248
List 5 ways to avoid foodborne and animal borne illness in immjnocompromised kids.
```
Pasteurized products
Avoid raw meat or seafood or eggs
Wash raw veggies thoroughly
Avoid food cross contamination
Avoid contact with ill animals
Avoid cleaning litter boxes, bird cages, or fish tanks
Wash hands after playing with animals
```
249
What are 2 risk factors for disseminated non typhi salmonella?
Immune compromise
Asplenia
Kid under 3
250
When should a patient with stool positive for non typhoid salmonella have a blood culture sent
Febrile
Under 3 months
Immjnocompromised
Or if visited a resource poor area in last 2 months and unsure type of salmonella
251
What antibiotic should be used to treat typhoid fever?
Azithro or ceftriaxone if systemically unwell
252
When do you use antibiotics in nontyphoidal salmonella?
When their is invasive infection or bacteremia
253
What do you do with salmonella typhi positive stool and negative blood culture with systemically well child
No treatment unless immunocompromised or under 3 months
254
What should you do if blood cultures become negative after 48 hr in ctx in a child with non disseminated s.typhi. What if it is disseminated or not negative at 48 hr?
Switch to azithromycin
| Consult ID and continue IV for up to 10+ days in patient
255
When can a child with varicella return to school?
Any time they feel well enough unless it is a camp for immunocompromised children then they should all be excluded until no more lesions.
This is because most infectious before rash and sickest kids stay home have highest viremia and break through disease in vaccinated kids is usually milder
256
What is the size criteria for a large local reaction to an insect sting?
10 cm or more
257
What is required to be a candidate for venom immune therapy? (2)
Systemic reaction to hymnoptera sting
| Positive hymnoptera skin test
258
What would be indications for someone with hymnoptera allergy to carry an EpiPen
```
Near fatal reaction
Severe honey bee allergy
Elevated serum tryptase level
Underlying medical condition
Those with frequent and unavoidable exposure
```
259
Do you need to allergy test and give and EpiPen to a systemic skin only reaction (full body hives) to a hymnoptera bite?
No
260
3 ways to avoid stinging insects
Don't walk barefoot outside
Careful when eating and drinking outdoors
Avoid opaque cans or straws
Wear gloves, long sleeves in high risk area or garden
Remove all insect nests around the home
261
What are the 7 most common allergens in children?
```
Cow's milk
Egg
Peanut
Tree nuts
Fish
Shellfish
Wheat
Soy
```
262
What are 2 biggest risks factors for food allergy?
Personal history of atopy
| 1st degree relative with atopy
263
When should allergenic foods be introduced to infants at high risk of food allergy?
4-6 no when developmentally ready
264
Other than early allergenic food introduction how can you prevent food allergy in high risk infants?
Breastfeeding until 2+ years
Introduce allergenic foods only one at a time
Offer allergenic foods a few times a week to maintain tolerance
265
What are 6 red flags for inflicted trauma in a young child with a fracture?
```
No history of trauma
Mechanism not compatible with age or stage
History changes
Delay in seeking help
Under 1 year age
Multiple fractures
Fractures of different ages
Presence of other injuries
```
266
What are high risk fractures for inflicted trauma?
```
Rib
Metaphyseal
Humerus fracture under 18 mo
Femur fracture when nonambulatory
Scapula
Sternal
Spinuous process
```
267
Name 4 causes of easy fractures other than accidental
```
Birth related
OI
Menkes
Infantile cortical hyperostosis
Hypophosphatasia
Tickets
Osteopenia of prematurity
Copper deficiency
Chronic renal insufficiency
Scurvy
Congenital syphilis
Osteomyelitis
Hypervitaminosis A
Methotrexate toxicity
LCH
Leukemia
```
268
What investigations should be done in all suspicious fractures for NAI?
```
CBC
Renal function and liver function
CA, phos, ALP
urinalysis
When indicated vit D 25 OH, PTH, Cu, ceruloplasmin
```
269
What imaging should be done in suspected NAI fractures? What imaging should you consider?
Skeletal survey immediately and again at 2 weeks if high suspicion but initial scan is negative
Consider neuroimaging
270
How must guns be stored in the home?
Away from children
Locked
Stores separately from ammunition
Remove from home is child with mood disorder or substance use
271
How should you manage BB gun or air soft gun shots?
Same as any other fun due to risk for high impact trauma
272
List 4 risk factors for influenza related complications
```
Under 5 years
Over 6 months with chronic health conditions
Indigineous people
Chronic care facility residents
Pregnant women
Over 65
```
273
When should you give a neuraminidase inhibitor for influenza even after 48 hr of symptom onsey
Hospitalized kids
Underlying medical condition or other risk factors (other than young age) can be considered
Severe or progressive symptoms
274
Typical duration of neuroamindase inhibitors for influenza
5 days
275
What is the best time interval to get neuroamindase inhibitors started after symptom onset
48 hr
276
What is a contraindication to neuroamindase inhibitors?
Under age 1
277
What is the definition of hypoglycemia in the first 72 he ofnpofe
2.6
278
What is the cut off for persistent hypoglycemia after the first 72 hr of life?
3.3
279
6 risk factors for neonatal hypoglycemia
```
SGA
IUGR
LGA
IDM
Under 37 wk gestation
Labetolol in mother
Late prem exposure to antenatal steroids
Perinatal asphyxia
Metabolic conditions
Syndromes with hypoglycemia (BWS)
```
280
What are the most common causes of neonatal hypoglycemia?
Impairment of gluconeogenesis (not enough substrate)
281
When can you stop screening for hypoglycemia in infants that are LGA IDM when the glucose remains above 2.6?
12 hr
282
When can you stop screening for hypoglycemia in infants that are SGA or preterm infanta when the glucose remains above 2.6?
24 hr
283
What blood glucose do you draw a crotical sample for in the first 72 hr of life and after?
Before 72 hr: 2.6
| After 72 hr: 2.8
284
How long should a patient be able to days before discharge home if they had neonatal hypogylcemia?
4-6 hr
285
How do you treat asymptomatic neonatal hypoglycemia with BG above 1.8 and how soon after do you recheck?
Breastfeed
Formula feed
Intrabucal dextrose
IV glucose if not PO intake 80mL/kg/day D10
Repeat glucose in 30 min
286
How do you treat symptomatic neonatal hypoglycemia or BG under 1.8?
2 mL/kg bolus D10
287
4 medications to treat hyperinsulism im NICU?
Steroids
Glucagon
Diazoxide
Octreotide
288
What are barriers to youth accessing contraceptives?
Cost (LARC, patch, and ring rarely covered)
Lack of confidentiality
Cost of condoms
289
Recommendations to improve compliance and uptake of contraceptives in youth (4)
Contraceptives in clinic
Fund full cost of all contraceptives
Ensure insurance companies do not report contraceptive use of dependents
If contraceptives are over the counter should ensure no cost until age 25
290
What are 3 mechanisms by which high flow works?
Minimized inspired room air
Washes out anatomical dead space
Small amount of PIP and PEEP
Upper and lower airway resistance reduced
291
3 conditions responsive to high flow?
```
OSA
Heart failure
Bronchiolitis
Asthma
Pneumonia or pneumonitis
```
292
What is the starting and max dose of high flow?
1-2 L/kg/min with max of 2 L/kg/mim
293
What FiO2 should you start high flow at?
50%
294
When should you wean the flow of high flow? When should you wean the FiO2?
1. When there is decreased WOB
| 2. When there is increase in sats
295
3 contraindications to high flow?
Nasal obstruction
Epistaxis
Severe upper airway obstruction
296
What are 3 techniques to help encourage families to get a vaccine?
Don't kick out of practice
Telling compelling true story
Use presumptive and motivational interviewing techniques
Use simple and clear language
Use the term community protection instead of hers immunity
Non judgemental
Validate concerns
Do not bring up vaccine myths they don't mention
297
What population in men B most common in? Men C?
B: under age 5
C: adolescents
298
Who should receive the men B vaccine and when should they get it?
High risk: asplenia, complement deficiency, primary antibody deficiency, HIV. Lab worker with meningococcus, military persons, travellers to endemic areas. Or close contact with Men B
2 mo, booster 1 year, every 3-5 years until age 7 then every 5 years
299
Who should get the MenC vaccine
All kids at 12 mo age and booster age 12
300
What can ciprofloxacin cause in children?
Cartilage destruction
301
What can ceftriaxone cause in infants under age 1?
High bilirubin
302
What can erythromycin cause in infants under age 2 mo?
Pyloric stenosis
303
What can tetracyclines cause in children?
Tooth staining
304
What can septra cause I'm infants under 2 months?
Kernicterus pop
