2020

Question 1

How many youth who use cannabis will develop problematic cannabis use?

A) 1/4

B) 1/6

C) 1/8

D) 1/10

Answer 1

1/6 of youth will develop problematic cannabis use

Question 2

Which of these statements is false?

A) Cannabis use before age 14 and using it at least monthly is strongly associated with adverse health impacts

B) In a recent Canadian survey, 20% of youth aged 16-19 reported using cannabis in the previous year

C) There is no clear evidence to support using medications to manage withdrawal symptoms or help adolescents with cannabis use disorder decrease use or quit

D) Those who have a family history of psychosis and depression should avoid using cannabis completely

Answer 2

Answer:

B) In a recent Canadian survey, 44% of youth aged 16 to 19 reported using cannabis within the previous year

Question 3

Which of these statements is incorrect?

1. Teens can be convicted for posessing and distributing child pornography, even when the picture they are sending is of themselves
2. All sexually active youth under 25 should be offered annual STI screening
3. A 14 year old can consent to sex with a 19 year old
4. Mid stream urine, urethral or cervical swab or self collected vaginal swab are all appropriate specimens for chlamydia and gonorrhea testing

Answer 3

Mid stream urine, urethral or cervical swab or self collected vaginal swab are all appropriate specimens for chlamydia and gonorrhea testing

Should be first catch urine

Question 4

What are the 7 P’s of a sexual health assessment?

Answer 4

‘7 Ps’: Partners, Practices, Protection from sexually transmitted infections (STIs), Past history of STIs, Prevention of pregnancy, Permission (consent), and Personal (gender) identity

Question 5

Which is not a risk factor for STIs?

A. Any drug use

B. Serial monogamy

C. >2 partners in the past year

D. Street involvement

E. All of the above are risk factors for STIs

Answer 5

E - all are risk factors

Question 6

Which statement is incorrect?

A. LGBTQ+ youth are at increased risk for STIs and susbtance use

B. A pregnancy test should be done if a sexually active youth has not had their period for more than 4 weeks or does not recall the last menstrual period

C. An anal swab should be done for chlamydia and gonorrhea in those who report receptive anal intercourse

D. G+C, syphilis, HIV, Hep A/B/C should be in routine STI screening for all sexually active youth

Answer 6

D. G+C, syphilis, HIV, Hep A/B/C should be in routine STI screening for sexually active youth

Offer G+C, syphilis, HIV for all sexually active youth

Consider Hep A/B/C serology in those with no or uncertain vaccination history, particularly if oral/anal contact, ir personal or partner history of IV drug use.

Question 7

True or False: There is clear evidence that Covid-19 can be transmitted via breastmilk.

Answer 7

False: not confirmed.

However 1 systematic review showed 9/84 samples of BM tested + for Covid, 6 infants were exposed and 4 tested +.

But could not confirm this was via BM transmission.

Question 8

When providing hospital care to Covid + mom and infant: rooming-in should be avoided in initial period. T/F

Answer 8

FALSE.

Mom with ?/+Covid should not be separated form infant

Discussion/SDM (risk/benefit)

and allow for “rooming-in”

Question 9

What does the CPS statement recommend to minimize risk of transmission of Covid-19 bw mom + baby?

A. Seperate Mom and baby

B. They can room in, but avoid breastfeeding

C. Can breastfeed, however use droplet precautions (mask and hand hygiene)

D. Use alternative method, such as EBM

E. Both C & D

Answer 9

Both C & D

Question 10

What does CPS recommend to reduce droplet transmission of Covid 19 during breastfeeding?

Answer 10

• Mom should wear mask + hand hygiene before
• Clean breast area w soap + water (if recently coughed/sneezed)
• Use of EBM (cleaning all equipment and common surfaces) is alternative
• Hospitalized mom/baby should also be encouraged to pump/use EBM until BFing established

Question 11

True or false?

“Pasteurized human donor milk contains the same amount of IgA as non-pasteurized human milk”

Answer 11

False – pasteurization decreases IgA

+ some protein is denatured

folate and vitamin D are degraded

Question 12

True or false?

“Donors for PHDM are required to be seronegative for hepatitis B, hepatitis C, HIV, HTLV and syphilis”

Question 13

True or false?

“Given the known benefits of human milk over formula and limited PHDM supply, physicians encourage the families to consider the option of informal unpasteurized donor human milk sharing within their community.”

Answer 13

False

CPS, health Canada, FDA all discourage the practice of informal milk sharing. Formula is considered the safer breast milk substitute for well newborns.

Question 14

What is the gold standard diagnostic test for congenital CMV?

Answer 14

Urine CMV PCR/shell vial assay (modified culture)

• serology is not recommended due to passive transfer of maternal antibodies
• screening for cCMV is done through newborn screening in Ontario as of July 2019
• Note: CPS statement technically listed saliva CMV PCR in non-breastfed infants as “gold standard” but in another table stated it was just urine CMV PCR/shell vial

Question 15

When should an infant’s sample be sent for cCMV diagnostic testing?

Answer 15

BEFORE 21 days postnatal age

• if testing is delayed beyond 21 days, it becomes difficult to distinguish between congenital infection vs. perinatally/postnatally acquired infection

Question 16

What percentage of infants with congenital CMV are asymptomatic?

A) 90%

B) 85%

C) 80%

D) 75%

Answer 16

Answer A) 90%

Question 17

For pregnant mothers, what interventions are recommended to decrease maternal acquisition of CMV?

A) CMV-specific hyperimmune globulin

B) Antiviral therapy

C) Hygienic measures

D) CMV vaccine

Answer 17

Answer is C = hygienic measures

• CMV-specific hyperimmune globulin & antiviral therapy for pregnant women with primary infection may provide benefit BUT robust evidence supporting this is lacking
• CMV vaccine does not exist at this time

Question 18

In an infant with suspected to have congental CMV, what would be your next steps in terms of evaluation? (excluding diagnostic testing)

Answer 18

• Labs: CBCD, bili, ALT/AST
• Head imaging: for minimal symptomatic/asymptomatic cases, start with HUS. if neurological symptoms or abnormal HUS, then order MRI
• Optho exam
• hearing test
• +/- ID referral (indications for referral: confirmed symptomatic cases, all cases of cCMV with SNHL (even if asymptomatic). could consider for probable cases)

Question 19

Which of the following infants would require treatment with anti-virals and what is the typical duration of therapy?

1. Infant with SNHL, 6 weeks of tx
2. Infants with mod-severe symptoms, 6 weeks of tx
3. Infants with mod-severe symptoms, 3 months of tx
4. Infant with mod-severe symptoms, 6 months of tx

Answer 19

Answer is 4 - Infant with mod-severe symptoms, 6 months of tx total

• Treatment with anti-retrovirals (typically oral Valgancyclovir) in infants who are severely symptomatic have shown improvement in neurodevelopmental & hearing outcomes for those treated for 6 months (vs 6 weeks)
• If infants are sick, can consider tx with IV Galcyclovir for 2-6 weeks and then transition to Valgancyclovir, for 6 mths total
• Treatment of infants with isolated SNHL is controversial

Question 20

What are side effects of antiviral therapy that should be monitored closely?

Answer 20

CBCD – Thrombocytopenia, neutropenia (q1wk x 1 mth, q2wk x 2 mths, qmonthly x 3 mths)

AST/ALT – Transaminitis (qmonthly x 6 months)

Urea/Cr – elevation (qmonthly x 6 months)

Question 21

Congenital CMV infants should be monitored closely. They require:

1. Regular audiology, optho follow up
2. Regular audiology, optho, neurodevelopmental follow up
3. Regular optho, neurodevelopmental follow up
4. Regular audiology, optho, neurodevelopmental, and dental follow up

Answer 21

Answer is 4 - regular audiology, optho, neurodevelopmental, and dental follow up

• Sequelae include: microcephaly, severe motor deficits (e.g. CP), intellectual delay, seizures, SNHL, ocular and visual abnormalities
• Symptomatic infants are at risk of dental hypoplasia

Question 22

A 15-year-old adolescent female is admitted for fever and weakness. She began her most recent menstrual period 3 days ago, and regularly uses tampons. On physical examination she is confused. Vital signs are: temperature 39.4°C, heart rate 150, respiratory rate 24, blood pressure of 80/24. She has diffuse erythroderma and her distal extremities are warm with bounding pulses and rapid CRT. She remains hypotensive despite 60 mL/kg of fluid boluses and initiation of appropriate antibiotics (cloxacillin and clindamycin).

What would be your next step in management?

1. Give another bolus of fluid (10 ml/kg)
2. Start epinephrine infusion
3. Start dopamine infusion
4. Start norepinephrine infusion

Answer 22

Answer 4 - start norepinephrine infusion

• this patient is in warm shock - primary goal is to increase systemic vascular resistance
• norepi has strong alpha adrenergic effects –> leading to primarily vasoconstriction
• Epinephrine has effects on alpha adrenergic and beta 1 receptors - would lead to effects on HR, contraction, and vasoconstriction

Question 23

Which vasoactive medication would you use for each of the following scenarios:

1) cold shock with normal BP
2) cold shock with low BP
3) warm shock with low BP

Answer 23

1) cold shock with normal BP - answer epinephrine 0.03-0.05 mcg/kg/min
2) cold shock with low BP - answer epinephrine 0.05 mcg/kg/min, inc by 0.02 mcg/kg/min as required. acceptable alternative is Dopamine 10 mcg/kg/min followed by epnephrine if efforts to reverse shock fail.
3) warm shock with low BP - answer norepinephrine 0.05 mcg/kg/min, inc 0.02 mcg/k/gmin as required

Question 24

What should be done in the golden hour of a patient presenting with sepsis?

Answer 24

• recognize severe sepsis & shock
• Cardioresp monitors, insert IV
• Assess ABCs –> provide oxygen +/- non-invasive ventilation PRN (intubate if cannot protect airway, inadequate ventilation/oxygenation, potential for clinical deterioration)
• fluid resuscitate - push 20 cc/kg of isotonic fluids, up to 60 cc/kg and then consider vasoactive medications if fluid refractory shock –> reduced urine output, metabolic acidosis, signs of volume overload (cardiogenic shock), vital signs and peripheral perfusion do not improve
• consider adrenal insufficiency and administering hydrocortisone
• give abx in first hour
• treat hypoglycemia
• Call ICU!

Question 25

True or false:

in order to be in septic shock, a patient has to have hypotension

Answer 25

Answer - false

• Septic shock is defined as “severe infection leading to cardiovascular dysfunction (including hypotension, need for tx with vasoactive medication, or impaired perfusion)
• Sepsis associated organ dysfunction in children as “severe infection leading to cardiovascular and/or noncardiovascular organ dysfunction”
• Derived from newly published guidelines by Weiss et al.

Question 26

An 8-year-old boy with nephrotic syndrome who is currently receiving daily corticosteroids presents with a one-day history of being generally unwell, diffuse abdominal pain, and multiple episodes of vomiting. On initial assessment he appears Cushingoid, and his vital signs are: heart rate 140, respiratory rate 30, temperature 37.5°C, blood pressure 88/32. CRT is less than 2 seconds and peripheral pulses are easily palpated. The patient is confused and somewhat uncooperative. His abdomen is distended and diffusely sensitive to palpation, with mild involuntary guarding.

True or false - this patient should be given stress dose hydrocortisone over fluid resuscitation

Answer 26

Answer - False

• As per CPS statement, no gold standard exists for the diagnosis of acute adrenal insufficiency in the context of critical illness
• for this scenario, CPS said abstention from hydrocortisone therapy would be acceptable, but they also said this child may benefit from stress dosing of hydrocortisone (50 mg/m2; then 100 mg/m2 per day div 3-4 doses) early in the course pbefore progression to septic shock
• bottom line.. its controversial

Question 27

A 10 year old child with history of IBD presents with watery diarrhea, 8-10 times per day, BP of 80/40, fever, and significant distention with rebound tenderness. What is the most appropriate treatment?

A. PO metronidazole 30 mg/kg/d div QID for 14 days AND IV vancomycin 40 mg/kd/g div QID

B. IV metronidazole 30 mg/kg/d div QID for 14 days AND PO vancomycin 40 mg/kd/g div QID

C. PO vancomycin 40 mg/kd/g div QID

D. PO vancomycin 40 mg/kd/g div QID and PR vancomycin 2g/day div QID

Answer 27

B. IV metronidazole 30 mg/kg/d div QID for 14 days AND PO vancomycin 40 mg/kd/g div QID. if complete ileus, add rectal vanco max 2g/d

*Vanco must be PO

Mild - no treatment <4 stools per day

Moderate > 4 stools = metronidazole 30 mg/kd/d div QID 10-14d

Severe - systemic toxicity (high grade fever) = vanco 40 mg/kg/d div WID x 10-14d

Severe + complicated (colitis, shock, peritonitis, ileus, megacolon, hypotension) = PO vanco + IV metronidazole x 10-14d. Add rectal vanco if ileus.

Question 28

Which of the following statements are false?

1. C diff colitis should be considered in a patient who received abx within the previous 12 weeks who has any diarrheal illness (watery or bloody)
2. The relapse rate with treatmnent for C diff is 15-35%
3. A patient who has been treated with a course of metronidazole PO previously who is now asymptomatic with persistent C diff + stool should be treated with a second course.
4. Older age, exposure to multiple antibiotic classes, chemotherpy and history of GI surgery are all risk factors for C diff

Answer 28

3. A patient who has been treated with a course of metronidazole PO previously who is now asymptomatic with persistent C diff + stool should be treated with a second course - false
   * Treatment does not eradicate C difficile or the toxin from the stool. Asymptomatic patients, if tested, should not be treated again simply because the stool test is positive.

Question 29

A healthy 10 month old previously treatment with C diff twice in the past now presents again with moderate symptoms with stool positive for C diff. The first episode was treated with metronidazole and the second with vanocmycin. What is the treatment now?

A. Repeat vancomycin course that was just given

B. Repeat regimen used for initial episode

C. vancomycin in a tapered or pulsed regimen

D. Consider other causes to explain clinical symptoms as patient is likely a carrier of C diff.

Answer 29

D. Consider other causes to explain clinical symptoms as patient is likely a carrier of C diff.

• Asymptomatic carriers: 15% to 63% of neonates, 3% to 33% of infants and toddlers younger than two years of age, and up to 8.3% of children older than two years of age
• Healthy infants under 1 year are not likely to have C diff diarrhea
• If patient was older
  
  • First recurrence - tx repeat initial regimen or vancomycin
  • Second recurrence - vanco in tapered or pulsed regimen

Question 30

Routine head imaging is recommended for all infants born at…

A. < 33 weeks

B. < 32 weeks

C. < 31 weeks

D. < 30 weeks

Answer 30

< 32 weeks

(i.e. up to 31+6 weeks)

Do routine HUS on DOL 4-7

Question 31

Which of the following are the risk factors for IVH in a preterm infant? (choose all)

A. Low birth weight (< 1kg)

B. Maternal corticosteroid use

C. Maternal chorioamnionitis

D. PDA

E. RDS

Answer 31

All except: maternal corticosteroid use (“lack of” Celestone is a risk factor).

Germinal matrix is fragile; fluctuation in cerebral blood flow increases risk of IVH

Question 32

An infant born at 26+2 weeks underwent a screening head ultrasound on Day 5 of life, which showed unilateral Grade 2 IVH. When do you repeat head imaging?

A. Head ultrasound in 2 days

B. Head ultrasound in 7 days

C. Head ultrasound at 4 weeks post-birth

D. MRI at 4 weeks post-birth

E. MRI at corrected term

Answer 32

B. HUS in 7 days

• When first imaging is abnormal (Grade 2 or higher, white matter injury), repeat HUS in 7-10 days to detect complications (e.g. post hemorrhagic ventricular dilation).
• “HUS at corrected term” if < 26 weeks, or abnormal prior HUS (grade 3+) or additional risk factors.
• Routine term-corrected MRI not recommended; predictive value limited

Question 33

1. Who is NOT considered at high risk of influenza-related complications?
   
   1. 17 y/o F pregnant w/ first baby, in her first trimester
   2. 4 y/o F starting kindergarten this year
   3. 7 y/o M w/ well-controlled constipation
   4. 7 y/o M, healthy, Aboriginal living on reserve

Answer 33

c) 7 y/o M w/ well-controlled constipation

Question 34

Which of the following patients has a contraindication to receiving LAIV this year?

1. 17 y/o F w/ hx of GBS, 3 months after receiving flu vaccine
2. 2 y/o F w/ an anaphylactic egg allergy
3. 6 y/o M who completed a course of PO dex 2 weeks ago for an asthma exacerbation
4. 4 y/o M on Flovent and Ventolin for asthma that has a wheeze

Answer 34

d. 4 y/o M on Flovent and Ventolin for asthma that has a wheeze

(LAIV contraindicated in

• Severe asthma
  
  • defined as current active wheezing or currently on oral or high-dose inhaled glucocorticosteroids, or medically attended wheezing w/in previous 7 days)

Question 35

Which patient has the correct dosing schedule for their very first flu vaccine?

1. 1 y/o F LAIV 0.1 mL EN, 2 doses at least 4 weeks apart
2. 9 y/o M IIV 0.5 mL IM, 2 doses at least 4 weeks apart
3. 9 y/o M IIV 0.5 mL IM x 1
4. 12 y/o F LAIV 0.1 mL EN, 2 doses at least 4 weeks apart

Answer 35

c. 9 y/o M IIV 0.5 mL IM x 1

• 1^st year that a child < 9 years of age receives influenza vaccine (either IIV or LAIV), 2 doses at least 4 weeks apart required.
• If child <9 years of age has received >=1 dose of any influenza vaccine in the past, only 1 dose is required this season
• Children >=9 years only 1 dose / year

Question 36

1. 4 y/o M w/ an asthma exacerbation and concurrent influenza infection has just completed a course of Tamiflu and is being discharged from hospital. He received the LAIV 48h prior to his symptom onset. What is the next best step in regards to influenza vaccination?
   
   1. He has received the LAIV and is covered for the season; no further action required
   2. Schedule a follow-up in your clinic to determine whether he has developed any further flu-like symptoms
   3. Give another dose of LAIV at least 48h after the course of Tamiflu is completed
   4. Give LAIV prior to discharge to ensure he is covered

Answer 36

c. Give another dose of LAIV at least 48h after the course of Tamiflu is completed

LAIV should not be administered until 48 h after d/c of antiviral agents, as these will inactivate vaccine virus.

If anti-influenza agent must be given w/in 2 weeks after receipt of LAIV, another dose should be given >= 48 h after d/c of therapy or give IIV.

Question 37

1. For which infant would hydrocortisone to prevent or treat BPD be recommended?
   
   1. 29 wk GA, uncomplicated pregnancy and delivery, for prevention
   2. 26 wk GA infant, maternal chorioamnionitis, starting in 1^st 24-48h after birth
   3. Ex-28 week GA infant on ventilator for 2 weeks with evolving BPD
   4. 32 wk GA infant on O2 for treatment of BPD

Answer 37

b. 26 wk GA infant, maternal chorioamnionitis, starting in 1^st 24-48h after birth

(high risk: <28 weeks GA, maternal chorioamnionitis)

Question 38

1. Ex-27 week GA male infant in the NICU remains ventilated after 1st week post-birth w/ increasing oxygen requirements and worsening lung disease. What treatment could be considered for BPD?
   
   1. Inhaled corticosteroid
   2. Corticosteroid mixed with surfactant via ET tube
   3. Hydrocortisone 1 mg/kg per day x 7 days, then 0.5 mg/kg per day x 3 days
   4. Dexamethasone starting with 0.15 - 0.2 mg/ kg/day, tapered over a short course

Answer 38

d. Dexamethasone starting with 0.15 - 0.2 mg/ kg/day, tapered over a short course

Question 39

An ex-27+2 GA infant, who was exposed to chorioamnionitis in utero, is admitted to the NICU and has just completed a course of hydrocortisone for prevention of BPD. Which of the following statements is true?

1. He may be at increased risk for late-onset sepsis
2. The hydrocortisone can be safely combined w/ indomethacin prophylaxis
3. Hydrocortisone prophylaxis was not appropriate for this patient as he had no risk factors for BPD
4. He may be at risk for a prolonged NICU stay

Answer 39

a. He may be at increased risk for late-onset sepsis

Question 40

Which of the following is recommended to prevent BPD?

1. Dexamethasone
2. Inhaled corticosteroids
3. Intubation
4. None of the above

Answer 40

d. None of the above

For prevention, for infants at highest risk for BPD (e.g., <28 weeks GA or exposed to chorioamnionitis)

• May consider prescribing hydrocortisone (physiologic replacement dose: 1 mg/kg/day x 7 days, then 0.5 mg/kg/day x 3 days) starting in 1st 24 to 48 h after birth

Question 41

Which of the following is recommended in treating an acute covid-19 infection in pediatrics?

1. Anti-virals
2. Steroids
3. Antibiotics
4. Supportive care

Answer 41

Answer 4 - supportive care

• there is no proven treatment at this time for covid-19 in pediatrics
• recommend AGAINST use of off-label/investigational studies therapies, as well as anti-virals at this time
• risk of secondary bacterial infxn is low, so abx is not recommended
• Supportive care recommended at this time

Question 42

Children/youth comprise a minority if cases of COVID-19 cases in high/middle income countries and their diseases tends to be milder.

True or false:

Suspected reasons for less symptoms in children include possible differences in ACE-2 receptor expression and blunting of inflammatory responses.

Answer 42

True

Question 43

True or false

Mortality in adults is due to ARDS and multi-organ dysfunction

Answer 43

True

Question 44

COVID-19 transmission in the pediatric population is from:

1. Person to person spread
2. Asymptomatic carriers
3. Airborne transmission
4. Options 1 & 2

Answer 44

Answer 1 - person to person spread

• Major risk factor is thought to be from household exposures
• Note: overall contribution of asymptomatic children to overall transmission remains unclear

Question 45

Current recommendations on general health measures and prevention strategies for covid 19 include:

1. Wearing a mask, ensuring to practice hand hygiene before/after masking and avoiding touching the mask
2. Physical distancing
3. Keep routine & booster vacinations up to date
4. All of the above

Answer 45

Answer - 4 all of the above

Question 46

True or false:

MIS-C / PIMS is due to an acute infection with COVID-19.

Answer 46

Answer - false

• MIS-C/PIMS is a post-infectious inflammatory syndrome that typically occurs 3-6 weeks after an acute infection
• Studies have shown that children usually negative for SARS-COV-2 on RT-PCR but test positive for antibodies

Question 47

Which of the following is NOT considered a distinguishing feature of PIMS/MIS-C (compared to KD):

1. Children with PIMS/MIS-C tend to be older in age at presentation compared to KD
2. MIS-C disproportionately affects children who are Caucasian, whereas children with KD typically are East Asian
3. MIS-C tends to have significant cardiac dysfunction and prominent GI features compared to KD
4. MIS-C tends to have higher inflammatory markers compared to KD

Answer 47

Answer 2

• PIMS/MIS-C disporportionately affects African/Afro-Carribean ethnicity

Question 48

Which of the following is NOT a biochemical hallmark of PIMS/MIS-C?

1. Thrombocytopenia
2. Elevated WBC count
3. Elevated CRP
4. Hypoalbuminemia

Answer 48

Answer 2 - elevated WBC count

• typically you see low WBC and elevated neutrophils

Question 49

True or false:

CPS describes PIMS/MISC presenting in one of 4 ways, which helps guide management.

Answer 49

Answer - false

• CPS describes PIMS/MISC presenting in 1 of 3 ways –> 1) Fever & hyperinflammation 2) KD 3) shock & shock-like states

Question 50

Management of PIMS-MISC includes all of the following, EXCEPT:

1. IVIG
2. Corticosteroids
3. Anakinra
4. Rituximab

Answer 50

Answer 4 - Rituximab

• Biologic agents including IL-1 inhibitors (e.g. Anakinra) may be considered in some cases (e.g. complicated KD presentation, MAS, KDSS)

Question 51

What are risk factors for neonatal HSV?

Answer 51

Newly acquired maternal infection

• First episode of primary infection (up to 60% risk transmission)
• 1st episode of nonprimary infection (<30% risk transmission)

PROM

Instrumentation (forceps, vacuum)

C/S reduces risk

Question 52

What is the best diagnostic test for neonatal HSV?

Answer 52

PCR testing of CSF, skin lesions, mucous membranes and blood is thought to be more sensitive

**CSF PCR could be falsely negative within 24-48h of illness. If index of suspicion is high, repeat within 72h of starting acyclovir

Question 53

How and when does neonatal HSV present?

Answer 53

In most cases, the initial symptoms of NHSV infection present within the first four weeks of life. Occasionally, disease presents for the first time between four and six weeks after birth.

Disseminated HSV (multiple organs eg. liver and lung);

Localized CNS HSV;

Skin, eye and mucous membrane (SEM) infection

Question 54

Neonate with fever and irritability, mother has suspected first episode genital HSV at delivery.

Management if vaginal delivery?

C/S?

Answer 54

Vaginal delivery OR C/S with ROM prior to C/S:

• swab mouth, nasopharynx, conjunctiva (controversial at birth or at 24h) before ACV
• Prophylaxis IV ACV x 10 days
• If positive swab, then blood and CSF PCR. If blood/CSF +, 21d treatment. If blood/CSF neg, then 14d ACV.

C/S without ROM:

• swab mouth, nasopharynx, conjunctiva at 24h
• If positive, readmit for CSF and blood, transaminases, then 14d ACV if blood/CSF neg and 21d if blood or CSF positive
• If negative, observe

Question 55

Duration of tx for neonatal HSV and things to monitor?

Answer 55

IV 60 mg/kg/d div q8h

Skin/eye/mucous membranes - 14d

CNS or disseminated (blood or CNS +ve) - 21d

• CSF should be sampled near end of 21 days and extended with weekly CSF sampling until negative PCR -> then d/c acyclovir
• Suppressive therapy with oral ACV (300 mg/m2 per dose TID) should be given for six months to infants with CNS disease

Monitoring

Monthly CBC and renal function - Neutropenia + nephrotoxicity

Neurodevelopment, ophthalmologic, hearing

Question 56

What are warning signs that should trigger further evaluation for CP?

Answer 56

1) Hand preference <12 months of age
2) Fisting persistent > 4 mo
3) asymmetries in movement or posture
4) Stiffness or tightness in legs <12 mo
5) inability to sit by 9 mo

Question 57

Treatment for lyme disease

Question 59

Which of the following statements are true?

1. If the mother is + for covid and the newborn has respiratory distress, the most likely etiology is also covid.
2. The is very low risk for vertical transmission for COVID
3. NICU resus team attendance is required if the mother has confirmed COVID
4. If the mother is + for covid, droplet/contact precautions during the initial steps of resuscitation is strongly recommended, particularly with CPAP/PPV and during intubation

Answer 59

1. If the mother is + for covid and the newborn has respiratory distress, the most likely etiology is also covid. - FALSE
2. The is very low risk for vertical transmission for COVID - TRUE
3. NICU resus team attendance is required if the mother has confirmed COVID - FALSE
4. If the mother is + for covid, droplet/contact precautions during the initial steps of resuscitation is strongly recommended, particularly with CPAP/PPV and during intubation - TRUE

Question 60

True or false?

1. If the mother has severe covid requiring respiratory support, the resus team should wear an N95 mask and eye protection for AGMP procedures for the infant
2. If the mother has COVID, delayed cord clamping should be avoided to avoid exposing the infant to possible COVID

Answer 60

1. If the mother has severe covid requiring respiratory support, the resus team should wear an N95 mask and eye protection for AGMP procedures for the infant - TRUE
2. If the mother has COVID, delayed cord clamping should be avoided to avoid exposing the infant to possible COVID - FALSE. low risk with delayed cord clamping and benefit outweights risk

Question 61

A 4 year old child presents with severe stridor and respiratory distress suggestive of croup. Their covid swab was positive 2 days ago. Unfortunately, there is a PPE shortage and no more airborne rooms available. What would you do for management?

1. Give ventolin via MDI + aerochamber
2. Give oral corticosteroids (dex)
3. Give oral dex with MDI, IM or SC epinephrine
4. Give oral dex and nebulized epinephrine
5. Call social work

Answer 61

Croup and COVID

For moderate to severe croup, administer oral corticosteroids (dex 0.6 mg/kg, max 16 mg/dose).

For severe croup, nebulized epi provided that full PPE available and airborne precautions can be taken

Alternatives include MDI, SC or IM

An MDI for epinephrine delivery has been urgently approved by Health Canada, but the evidence is extremely limited for use in croup. Equivalent dosing is extrapolated from limited studies - current recommendations suggesting 2 puffs for infants under 1 year of age, and 4 puffs for older children. Repeat dosing q15 min based on clinical assessment

In settings where all airborne precautions cannot be taken, delivering epinephrine SC or IM may be considered, with dosing based on weight, as follows:

7.5 to 15 kg: 0.1 mg IM/SC
15 to 30 kg: 0.15 mg IM/SC
>30 kg: 0.3 mg IM/SC

Question 62

In the management of pediatric COVID, which of the following therapies are supported by evidence?

1. Dexamethasone
2. IVIG
3. Antiviral treatment
4. Tocilizumab
5. None of the above

Answer 62

None of the above are supported by evidence

Symptomatic – O2, NG or IV hydration when unable to tolerate PO

Some early concerns about ibuprofen use increasing risk for COVID-19 mortality and morbidity are not supported by evidence, and current therapeutic practice continues to be recommended

In cases of severe disease, additional pressure and ventilatory support may be required, including intubation

If evidence for a secondary infection, antibiotics should be administered pre-emptively

For sepsis, IV 3rd gen cephalosporin +IV vancomycin for severe disease

For pneumonia, intravenous ampicillin or oral amoxicillin

Question 63

What is NOT considered an AGMP?

1. HFNC
2. Oxygen
3. Bag mask
4. CPAP
5. Intubation
6. Suction

Answer 63

Answer - 2 Oxygen (all the other ones are considered AGMP)

Question 65

In which of the following situation, is the use of adjuvant corticosteroids recommended for the treatment with meninigtis?

A. 3 week old term female with suspected GBS meningitis

B. 5 year old male with VP-shunt presenting with change in LOC, suspected meningitis

C. 8 year old unimmunized female with meningitis, CSF gram stain showing gram-negative coccobacilli

D. 6 year old partially immunized male with meningitis, CSF gram stain showing gram-negative cocci

E. 3 year old female with confirmed meningococcal meningitis

Answer 65

Answer: C

Use adjuvant steroids if:

CSF gram stain shows coccobacilli consistent with H. influenzae;

or presumptive S pneumoniae meningitis

Continue steroids for 4 days if H. influenzae/S. pneumo confirmed, discontinue within 48 hours if other pathogen

Question 66

List the following pathogens from the shortest to the longest recommended duration of antibiotics for meningitis treatment

GBS

S. pneumoniae

H. influenzae

N. meningitidis

Answer 66

N. meningitidis = 5-7 days

H. influenzae = 7-10 days

S. pneumoniae = 10-14 days

GBS = 14-21 days

Remember “NHS, GBS”

Question 67

List 4 contraindications to LP

Answer 67

1. coagulopathy
2. cutaneous lesions at the proposed puncture site
3. signs of herniation
4. unstable clinical status

Question 68

When is the earliest time homogenized (3.25%) cow’s milk can be introduced to an infant?

A. 6 months

B. 9 months

C. 12 months

D. 15 months

Answer 68

Answer: B. 9 months

“Delay whole milk introduction at 9-12 months, max 750ml/day”

Question 69

Which of the following complementary food is NOT recommended for a 15 month old child? (choose all)

A. Homogenized (3.25%) cow’s milk

B. Commercial formula

C. Honey

D. Fortified soy milk (family is vegan)

Answer 69

Answers:

B. Comercial formula (No commercial formula beyond 1 year)

D. Soy milk (Soy, rice, other plant-based beverages are inappropriate alternative to cow’s milk in the first 2 years)

Question 70

Types of medication errors include all except:

a) Wrong medication
b) Wrong dose prescribed/administered
c) Wrong concentration or preparation
d) Unsafe disposal/storage of medication
e) Incorrect duration or frequency

Answer 70

d) Unsafe disposal/storage of medication

Question 71

Factors contributing to risk of medication error in CMC include all except:

1) Polypharmacy
2) Multiple caregivers
3) Multiple prescribers
4) Uncommon medications such as off label uses
5) Frequent ED visits

Answer 71

5) Frequent ED visits

Question 72

True or false.

Suicide is the 3rd most common cause of death among Canadian adolescents

Answer 72

Answer - false.

• it’s the second most common cause of death amongst Canadian adolescents
• They account for 25% of deaths in age group 15-19 in 2011

Question 73

Which of the following statements is false?

A. Males are more likely to die from suicide vs females

B. Females are 4-5 times more likely to attempt suicide vs males

C. Aboriginal youth have 4-5 times greater suicide rates compared to non-Aboriginal youth

D. Adolescence have higher rates of suicide attempts and completed suicide vs. pre-pubertal children

Answer 73

Answer - B

• Females are 3-4 times more likely to attempt suicide vs. males

Question 74

You see a youth in the ED who has been brought in by her mother after she disclosed she had taken multiple tylenol tablets at home (the event occurred 1 hour ago). She is currently stable and her vital signs are within normal limits. She did not consume a toxic dose but she is waiting in the ED for further testing. What should you do first when you see her?

A. Explore the intent around tylenol ingestion

B. Explore suicidal ideation, intent and any plans surrounding the event

C. Ask to interview her alone and inform the patient on limits of confidentiality

D. Gather a history including past medical history (e.g. mental health history), precipitating factors, risk factors, family history, and a HEADSSS assessment (including a suicide history)

Answer 74

Answer - C

“Adolescents should be informed of the limits to confidentiality as early in the assessment as possible.”

Question 75

Crucial aspects in performing an assessment of suicideal behaviour in a youth includes:

A. Gathering information on precipitating factors

B. Gathering information on risk factors

C. past medical history (inclusive of mental health), past suicide attempts/ideation, information around current attempt/ideation

D. Ensure there are appropriate supports in place including follow up and a safety plan

E. All of the above

Answer 75

all of the above

Question 76

What is one of the strongest predictors of suicide during adolescence and lifelong?

Answer 76

Previous suicide attempt

Question 77

1. Which of the following exposures increase the risk of a fungal infection in an immunocompromised child? (choose all)

A. Construction site

B. Farm

C. Cave

D. Marijuana smoking

Answer 77

All of the above!

Avoid risk of exposure to fungal pathogens by:

• Minimizing exposures to construction, excavation and renovations sites, where fungal spores (e.g., Aspergillus) can thrive.
• Minimizing inhalation of fungal spores from plants and animals (i.e. in farms, barns or pigeon coops, or from mulching, turning compost piles or cave exploration).
• Not smoking marijuana.

Question 78

Match the pets with potential pathogens they carry

1. Chicks
2. Mouse
3. Fish tanks
4. Kittens

A. Salmonella

B. Mycobacterium marium

C. Bartonella

D. Lymphocytic choriomeningitis virus

Answer 78

Chicks + reptiles: Salmonella

Mouse: lymphocytic choriomeningitis virus

Kittens: Bartonella

Cats: Toxoplasma gondii

Fish tank: Mycobacterium marium

Question 79

(In children with asplenia) name the pathogen…

1. Most common organism causing sepsis
2. Organism responsible for sepsis associated with cat/dog bites

Answer 79

1. Most common organism causing sepsis – S. pneumoniae
2. Organism responsible for sepsis associated with cat/dog bites – Capnocytophaga canimorsus (need antibiotics, amox/clav) *indications for antibiotics in early presenting, uninfected wounds*

Question 80

What is a typical duration of antibiotic prophylaxis in children with aplenia?

Question 81

Name all the supplemental immunizations that children with asplenia/hyposplenia should receive.

Answer 81

1. PCV13 x 4 doses before 15 mo (vs. 3 doses in healthy children)
2. PPV23 at 2+ yo & boosters q 5yo (none for healthy children)
3. MenACWY (Menveo/Manactra) before 2yo & boosters q 5yo (vs. grade 7 in healthy children)
4. 4CMenB before 2yo (none for healthy children)
5. Hib x 4 (same as healthy children)

Question 82

Which of the following is not a contraindication to breastfeeding?

A) HIV

B) Radiation therapy

C) Galactosemia

D) PKU

Answer 82

PKU (previous contraindication; now encourage breastfeeding to supplement a low-phenylalanine formula, along with strict monitoring of phenylalanine levels

• BF contraindications
  
  • HIV
  • Cytotoxic chemotherapy, radioactive isotopes or radiation (no BF during treatment)
  • Galactosemia

Question 83

Which of the following is not true about breastfeeding?

A. limit EtOH as EtOH passes freely into breast milk

B. interruption of breastfeeding is not recommended for physiological jaundice or for breast milk jaundice

C. The CPS recommends exclusive breastfeeding for the first 6 months

D. In Canada, 87-89% are exclusively breastfeeding at 6 months

E. Each additional month of breastfeeding may reduce the hospital admission rates from infection by 30%

Answer 83

In Canada, 87-89% are exclusively breastfeeding at 6 months - FALSE

• BF rates: initiation is high (87-89%), drop off to 25% at 6mo (highest in BC & Yukon, lowest in Eastern provinces)

Question 84

Which is not a criteria for discharge for a prem infant?

a. no apneas for 5-7 days
b. spO2 >95% for 1 week
c. sustained weight gain and feeding by bottle or breast
d. appropriate thermoregulation

Answer 84

b. spO2 >95% for 1 week

• Most suggest a target SaO2 of approximately > 90% to 95% for infants with BPD
  
  • Margin of safety when infants may experience oxygen desaturation, such as sleep and feeding.
  • Many centres monitor SaO2 in room air for approx. one week before discharging

CPS

Question 85

Which is false regarding discharge preparation of a prem infant?

A. Preterm infants with a birthweight <2000 g require four doses of Hep B in general

B. Preterm infants should have follow up with a GP within a 72h of discharge

C. Apnea of prematurity is a risk factor for SIDS

D. Home cardiorespiratory monitoring is rarely indicated for apnea of prematurity

Answer 85

C. Apnea of prematurity is a risk factor for SIDS - false

Question 86

What are the correct definitions of overweight and obesity, respectively?

a) overweight (BMI 2 SD above mean ); obese (BMI >2 SD above mean)
b) overweight (BMI 1 SD above mean ); obese (BMI >1 SD above mean)
c) overweight (BMI >2 SD above mean ); obese (BMI 2 SD above mean)
d) overweight (BMI >1 SD above mean ); obese (BMI 1 SD above mean)

Answer 86

a) overweight (BMI 2 SD above mean ); obese (BMI >2 SD above mean)

Question 87

Which of the following health outcomes are NOT associated with sugar-sweetened beverages?

a) overweight and obesity
b) diabetes
c) some cancers
d) autoimmunity

Answer 87

d) autoimmunity

Question 88

What does the CPS recommend to decrease the purchase of SSBs?

a) Decrease taxes by 10% on fruits and vegetables
b) Decrease taxes by 20% on healthy active living programs
c) Excise tax of at least 20% be applied to all SSBs sold in Canada
d) Impose tax of at least 20% on all drinks including SSBs bought from vending machines

Answer 88

c) Excise tax of at least 20% be applied to all SSBs sold in Canada

Question 89

What can institutions do to work towards reducing TB in indigenous communities?

a. Ensure all staff + students complete cultural safety training
b. Consult with First Nations, Inuit and Métis communities to minimize barriers to

diagnosis and treatment TB

c. Incorporate First Nations, Inuit and Métis healing practices into care pathway
d. Increase number of First Nations, Inuit, Métis people working in organization
e. Encourage interested HCPs to develop sustainable models of Indigenous-

focused care

f. All of the above

Answer 89

f. All of the above

Question 90

1. What can HCPs do to work towards reducing TB in indigenous communities?
   a. learn about which groups are at increased risk for TB
   b. Learn about the history and current impact of health care and TB control for First Nations, Inuit and Métis people and how this shapes your role
   c. Work with First Nations, Inuit and Métis families to co-develop TB care plans that meet their needs
   d. Share culturally appropriate information on TB
   e. Create safe spaces when caring for First Nations, Inuit and Métis families
   f. All of the above

Answer 90

f. All of the above

Question 91

Which of the following statements regardign school nutrition policy (SNPs) is false:

1. Development can be complex and typically involves multiple stakeholders (e.g. dieticians, teachers, parents, students, etc)
2. They are generally developed at a provincial/territorial level
3. They should encompass cultural variation and be sensitive to different social/economic backgrounds of students
4. Schools/school boards have a nutrition committee to oversee implementation

Answer 91

Answer - 4

Question 92

Select ALL that apply. At minimum, SNPs should aim to achieve the following:

1. improve quality of food and beverage intake and choices
2. help students make healthier nutritional choices
3. build skills that enhance healthy dietary behaviours
4. reduce risk for overweight, obesity, and eating or nutrition-related disorders

Answer 92

Answer - all of them!

Question 93

What are some potential impacts of SNPs? Choose all that apply.

1. Increasing access to nutritious foods & beverages
2. Improving dietary behaviours
3. Lowering BMI
4. Improves academic performance

Answer 93

Answer - 1,2,3.

• studies show mixed results in terms of impacts on academic performance

Question 94

SNPs should:

1. Have appropriate supports to facilitate adherence and optimal implementation
2. Only involve school nutrition councils in certain circumstances
3. Promote nutrient rich foods and beverages and make no changes to access to foods/beverages that may have higher sugar/sodium/fat content
4. Implement nutritional changes at special events (e.g. festivals, concerts, sport games)

Answer 94

Answer - 1

Question 95

What are advantages of pulse oximetry screening in newborns?

1. Cost-effective
2. Safe, non-invasive
3. Easy to perform
4. can be used in adjunct to physical examination and prenatal u/s to help identify critical congenital heart disease

Answer 95

They’re all correct!

Question 96

Which infants should be screened with pulse ox screening?

1. 33 wks & above, 24-36 hours
2. 33 wks & above, < 24 hours
3. 34 wks & above, 24-36 hours
4. 34 wks & above, < 24 hours

Answer 96

Answer - 3

• Infants who are ASYMPTOMATIC in NON-acute care settings should be screened
• all infants 34 weeks & older should be screened between 24-36 hours of life –> if discharged < 24 hours, better to screen (than no screening) or can be arranged in follow up

Question 97

Where should pulse ox screening be performed in infants? (e.g. left hand etc)

Answer 97

right hand AND either leg

Question 98

What is considered an abnormal and borderline result on pulse ox screening?

1. Abnormal < 90%, borderline 90-94% in either limb or > 3% difference
2. Abnormal < 90%, borderline 90-95% in either limb or > 3% difference
3. Abnormal < 92%, borderline 90-94% in either limb or > 3% difference
4. Abnormal < 92%, borderline 90-95% in either limb or > 3% difference

Answer 98

Answer - 1

Question 99

If an infant has an abnormal screen with pulse ox screening, what should be done next?

1. Most responsible healthcare provider should assess the infant
2. Refer to pediatrician (if not most responsible healthcare provider)
3. Refer to cardiology
4. 4 limb BP, CXR, ECG

Answer 99

Answer - 1

Infant needs to be assessed by most responsible healthcare provider (e.g. midwife, nurse, MD) –> most responsible HCP should consider 4 limb BP, ECG, CXR (and probably palpating central pulses e.g. femoral)

Consult pediatrician +/- cardio (to perform echo if you cannot r/o cardiac reason for hypoxemia)

Question 100

5 year old child with platelets of 15. RBC and WBC normal. No acute bleeding. Had epistaxis last week which took a long time to resolve. Non-blanchable spots are seen on his legs and inner lip.

Management?

A. Observation, no contact sports

B. Corticosteroids or IVIG

C. Admission to hospital, IV methylpred +IVIG+ platelet transfusion

Answer 100

B - corticosteroids or IVIG

• No active bleeding or very mild
  
  • Strongly consider observation as the first-line approach, with oral corticosteroids or IVIG as second-line options
• Moderate bleeding
  
  • More severe skin manifestations, some mucosal lesions and more troublesome epistaxis or menorrhagia
  • Treatment options include a single dose of IVIG (0.8 g/kg to 1.0 g/kg) or a short course of corticosteroids.
  • Intravenous anti-D immune globulin (anti-D) can only be used in Rh-positive children and is generally not considered as first-line therapy due to rare but serious adverse effects
• Severe bleeding (3%)
  
  • Immediate treatment in hospital with intravenous steroids and IVIG is indicated. Tranexamic acid may help as an adjunct therapy at a dose of 25 mg/kg/dose orally, 3 to 4 times per day (maximum 1500 mg per dose), or 10 mg/kg/dose IV every 8 hours.

Question 101

A child was dx with ITP (mild, no bleeding) and receiving close observation.

What do you counsel the family? Choose all that are true.

A. The transfusion threshold is platelets 20 or lower

B. Avoid contact sports and activities that may cause injuries, particularly to the head

C. Avoid NSAIDS

D. Remind Doctors and dentists about this condition

E. It is a self resolving condition, 75-80% resolve within 2 months, and the rest resolves in 6 months.

Answer 101

A. The transfusion threshold is platelets 20 or lower

• False. Platelet transfusion is generally contraindicated except for acute, life-threatening bleeds or in children requiring immediate surgery

B. Avoid contact sports and activities that may cause injuries, particularly to the head - true

C. Avoid NSAIDS- true

D. Remind Doctors and dentists about this condition - true

E. It is a self resolving condition, 75-80% resolve within 2 months, and the rest resolves in 6 months.

• false. self-resolves in 6 months in 75-80% of cases, most of the remaining resolves within 12 months

Question 102

A child with moderately severe ITP was treated with prednisone x4 days. When do you usually expect an increase in platelets to occur?

A. within 24 hours

B. within 48 hours

C. within 72 hours

D. after 4 days of treatment

Returning 3 weeks later with worsening petechiae and platelets of 10. What do you do now?

A. Counsel the family that we should continue to observe closely and expect it will resolve by 8 weeks

B. Consider treatment with IVIG

Answer 102

• After prednisone, expect platements to increase within 48 hours
• After IVIG, expect increase in platelets within 24h, peak at 2-7 days
• For children who do not respond initially, further treatment may involve switching to a different modality (e.g., from IVIG to corticosteroids or vice-versa).
• Approximately one-third of children who respond to treatment initially will relapse, with platelet counts falling below 20 x 109/L within 2 to 6 weeks. Retreatment decisions should be based on similar criteria to those initially considered, with modality depending on tolerance of and response to previous treatment agents.

Question 103

Which SSRI has the most data supporting its use for treatment in depression (For both children and adolescents)?

1. Escitalopram
2. Citalopram
3. Fluoxetine
4. Fluvoxaminet

Answer 103

Answer C - Fluoxetine

• Data is most supportive for the efficacy of Fluoxetine, demonstrating the greatest difference b/w active drug & placebo

Question 104

Which SSRI has the most data supporting its use in treatment of anxiety in children & adolescents?

1. Escitalopram
2. Citalopram
3. Fluoxetine
4. Fluvoxamine

Answer 104

trick question - they’re all correct.

• Data has not shown superiority of one SSRI over another in the treatment of anxiety disorders

Question 105

If citalopram is being used to treat a patient for depression, what dose should not be exceeded and what group of children should this medication not be prescribed to?

1. 25 mg/day, congenital heart disease
2. 30 mg/day, risk of arrhythmias
3. 35 mg/day, hepatic impairment
4. 40 mg/day, congenital long QT syndrome

Answer 105

Answer 4

• QT prolongation & risk of arrhythmia occur in children with doses > 40 mg/day
• Citalopram should be avoided in patients with congenital long QT syndrome – cautious in those with CHD, hepatic impairment, risk of arrythmias due to lyte disturbances

Question 106

You see a 15 year old female with depression and she has had increasing suicidal thoughts. Her symptoms are starting to impact her school performance. She is not on any other medications and is otherwise healthy. You decide you’d like to start her on a SSRI. Her mother expresses concern regarding suicidality risk. What do you do?

1. Respect her wishes and look to start a different medication
2. Respect her wishes and utilize non-pharm therapies (e.g. CBT)
3. Listen to her concerns and explain untreated depression may be more harmful and would not outweigh benefits of starting a SSRI
4. Refer her to psychiatry

Answer 106

Answer 3

• Collectively research suggests:
  
  • The potential benefit of SSRI use outweigh the potential harms for the tx of depression in children & adolescents
  • Untreated depression is more likely to result in harm vs appropriate SSRI use
  • Close initial monitoring, along with careful documentation of symptoms & adverse effects, are required

Question 107

Which of the following are true regarding anaphylactic reactions to PCN abx:

1. Family history increases risk in individual
2. Long term and high dose PO therapy increases risk of developing allergy
3. Anaphylaxis is rare <1% of children/adults
4. It is not a contraindication for performing PO drug challenge to suspected Abx

Answer 107

3

1. Family history increases risk in individual - does NOT increase
2. Long term and high dose PO therapy increases risk of developing allergy - IV not PO
3. Anaphylaxis is rare <1% of children/adults - TRUE
4. It is not a contraindication for performing PO drug challenge to suspected Abx - it is a contraindication if recent anaphylactic

Question 108

Which statement is correct regarding intradermal testing

1. It is recommended by international guidelines for assessment of suspected IgE mediated allergy
2. NPV of this test is very high , approaches 100% in children an adults
3. Its is a useful test in screening for allergy where the history may not be convincing for a reaction
4. The NPV is reported to be as low as 40% in children

Answer 108

1

1. It is recommended by international guidelines for assessment of suspected IgE mediated allergy
2. NPV of this test is very high , approaches 100% in children an adults - no it does in adults , NPV lower in kids
3. Its is a useful test in screening for allergy where the history may not be convincing for a reaction -NOT A USEFUL SCREEN if no convincing hx
4. The NPV is reported to be as low as 40% in children - nope that’s PPV

Question 109

5 year old girl developed hives, 12 h after 2nd dose of beta lactam Abx. Which of the following would be the best course for management:

1. Low risk, therefore prescribe again or proceed with antibiotic as likely non allergic/IgE mediated reaction
2. Skin test, if negative proceed with using Abx again
3. Skin test, if negative proceed with other antibiotic with similar side chain
4. Needs oral challenge and if negative proceed with use of Abx again

Answer 109

4

1. Low risk, therefore prescribe again or proceed with antibiotic as likely non allergic/IgE mediated reaction - NOPE, see algorithm for low risk
2. Skin test, if negative proceed with using Abx again —> ST only for PCN
3. Skin test, if negative proceed with other antibiotic with similar side chain —> even if neg not for other ABx
4. Needs oral challenge and if negative proceed with use of Abx again

Question 110

Select incorrect statement:

a. Pt with hx of suspected Pen rxn but tolerated 1 course is not allergic.
b. Pt determined to be low risk for PCN allergy can be prescribed cephalosporin classes, similar or dissimilar side chain, without monitoring
c. Pt with suspected IgE allergy to PCN, you could prescribe another cephalosporin with dissimilar side chains
d. Pt with diagnosed PCN allergy by allergist should be reassessed after 3 years. It can be outgrown and avoiding penicillin for life may not be necessary.

Answer 110

Select incorrect statement:

a. Pt with hx of suspected Pen rxn but tolerated 1 course is not allergic.
b. Pt determined to be low risk for PCN allergy can be prescribed cephalosporin classes, similar or dissimilar side chain, without monitoring
c. Pt with suspected IgE allergy to PCN, you should prescribe another cephalosporin with dissimilar side chains
d. Pt with diagnosed PCN allergy by allergist should be reassessed after 3 years. It can be outgrown and avoiding penicillin for life may not be necessary. —> incorrect its 5 years

Question 111

By age 17, more than 50% of youth are sexually active. Which of the following is FALSE in terms of contraception?

1. The bridging method should be used if there are anticipated delays with a LARC
2. Failure rates decrease if multiple tiers are used
3. Contraception should be started during menses
4. Condoms should be used to reduce STI risk

Answer 111

Answer 3

Quick start method should be used as you may increase risk of pregnancy by delaying starting a contraception

Question 112

At what body weight is a transdermal patch not effective?

1. > 70 kg
2. > 80 kg
3. > 90 kg
4. > 100 kg

Answer 112

Answer 3, > 90 kg

Question 113

If a youth decides to start depot medroxyprogesterone acetate (DMPA) injections, what is important to discuss with her?

1. Vitamin D & calcium supplements are not important
2. She can continue with her usual ETOH/caffeine intake, smoking patterns
3. She should engage in resistance exercises
4. weight gain is an issue

Answer 113

Answer 4 - weight gain is an issue

She should also be counseled on:

• Taking Vitamin D & calcium supplements given concerns of dec BMD
• Engage in weight bearing exercises
• Reduce smoking/ETOH/caffiene consumption

Question 114

When initiating contraception, all of the following should be performed except?

1. Gather a good history, take BP & weight
2. Pelvic exam and STI testing is not required in order to initiate contraception, but STI screening should be offered in sexually active youth
3. Consider providing a long term prescription (e.g. 12 months) for the youth
4. Starting dose for estrogen in COC is typically 25-30 mcg

Answer 114

Answer 4 - the starting dose is typically 30-35 mcg of EE and can be given in either 21 active or 84 active pills (extended use)

Question 115

Which of the following are risk factors for OE? Select all that apply

1. Immunocompromised
2. Tight head scarves
3. Chronic otorrrhea
4. Hearing aids
5. Trauma to the ear

Answer 115

Answer - all of the above

• additional risk factors include swimming, FB in ear, pinna ear piercing

Question 116

Which of the following are common organisms in OE?

1. S. pneumo
2. GN bacteria
3. Pseudomonas
4. S. aureus

Answer 116

Answer - 3 & 4

• GN bacteria are less common
• fungal organisms are rare
• most common are S. aureus & pseudomonas

Question 117

Management of acute otitis externa include (choose all that apply):

1. Polysporin drops are first line
2. Topical abx +/- topical steroid
3. Analgesics
4. Aural toileting

Answer 117

Answer - 2 & 3

• treat with topical abx +/- topical steroids for 7-10 days in mild to modere cases
• in severe cases, consider systemic abx that would provide coverage for S. aureus and pseudomonas
• avouid ototoxic agents in patients with tubes OR you cannot visualize the TM

Question 118

Who is at risk for malignant otitis externa and what is the management of this?

1. Child with thyroid disease, CT/MRI, surgery consult with abx
2. Child with diabetes, CT/MRI, surgery consult with abx
3. Child with asthma, CT/MRI, surgery consult with abx
4. Child with celiac disease, CT/MRI, surgery consult with abx

Answer 118

Answer - 2

• other risk factors include immunodeficient patients
• presentation with CN VII palsy and pain

Question 119

What is considered a high risk injury for HIV (select all that apply)?

1. Source is unkown but presumed or there is a known high prevalence of HIV in the local IVDU population
2. Large lumen needle
3. Visible blood in needle/syringe
4. Injuries with blood injection
5. Extensive splashes involving large amounts of blood onto non-intact skin

Answer 119

Answer - all of the above

Question 120

Which child will require a HBV vaccine in the context of a needle stick injury?

1. A child who has been fully vaccinated with positive Anti-HBsAg antibodies
2. A child who has been fully vaccinated with negative Anti-HBsAg antibody, positive HBsAg
3. A child who has NOT been fully vaccinated and tests negative for antigen and antibody
4. A child who has NOT been fully vaccinated and tests positive for HBsAg

Answer 120

Answer - 3

1. A child who has been fully vaccinated with positive Anti-HBsAg antibodies –> already immune
2. A child who has been fully vaccinated with negative Anti-HBsAg antibody, positive HBsAg –> acquired infxn, requires f/u
3. A child who has NOT been fully vaccinated and tests negative for antigen and antibody –> this is the answer; this child would also require Hep B immunoglobulin
4. A child who has NOT been fully vaccinated and tests positive for HBsAg –> similar to #2, already acquired infection so requires f/u

Question 121

In a child who requires ART prophylaxis (which is indicated in high risk HIV exposures), which of the following is FALSE?

1. prophylaxis should be started ideally within 1-4 hours of injury but can be initiated within 72 hours
2. total duration of prophylaxis is 28 days
3. the child requires close f/u to monitor for side effects and adherence
4. serologies do not need to be checked since prophylaxis is being provided

Answer 121

Answer - 4

1. prophylaxis should be started ideally within 1-4 hours of injury but can be initiated within 72 hours
2. total duration of prophylaxis is 28 days
3. the child requires close f/u to monitor for side effects and adherence –> CBCD, liver enzymes & renal fnc need to be checked midway and at the end of prophylaxis (i.e. 2 & 4 weeks)
4. serologies do not need to be checked since prophylaxis is being provided –> serologies need to be checked between 4-6 wks +/- 3 months +/- 6 months
   - If initial HIV Ab positive at 4-6 wks, don’t need to rpt
   - If initial HIV Ab negative at 4-6 wks, then rpt at 3 mths
   - If rpt at 3 mths is NEGATIVE, then do NOT need to rpt at 6 mths (essentially checking for seroconversion)

Question 122

Which of the following is false?

1. Hep B is the most stable virus and has highest risk of transmission
2. There is post-exposure prophylaxis for Hep B, Hep C, and HIV
3. HIV and Hep C are more fragile viruses
4. HIV has the lowest risk of transmission compared to Hep B & C

Answer 122

Answer - 2

There is no post exposure prophylaxis for Hep C

Question 123

Which of the following are true regarding neonatal ophthalmia neonatorum?

A. Ocular prophylaxis with Erythromycin should NOT be routinely recommended because it may no longer be useful due to increasing gonorrhea resistance

B. Ocular prophylaxis with Erythromycin should NOT be routinely recommended because it is not effective for chlamydia

C. Prenatal STI screening is the best way to prevent neonatal ophthalmia

D. Some provinces legally mandate ocular prophylaxis with erythromycin

Answer 123

All of the above are true!

Question 124

Mom is gonorrhea + at time of delivery, baby born and well appearing. what is the next step?

A. Swab baby, If positive, then treat with ceftriaxone IM/IV x1

B. Swab baby but do not wait for the swab and treat anyway with Ceftriaxone IM/IV x 1

C. Monitor clinically and swab/treat if symptoms develop

D. Swab baby, do blood and CSF Cx and treat empirically with ceftriaxone.

Answer 124

Exposure to Gonorrhea – test and treat immediately (vaginal or C/S)

§ Conjunctival cx & give Ceftriaxone 50mg/kg x 1 IV/IM (single dose so no risk of biliary stasis, contraindicated if receiving IV calcium)

§ Cefotaxime 100mg/kg IV/IM x 1 acceptable alternative and consider Rx for concurrent chlamydia regardless of mode of delivery

§ If unwell, blood and CSF Cx

Question 125

Mom was positive for chlamydia prior to delivery. Baby born by vaginal delivery and well. No social concerns. Which of the following is true?

A. Infant prophylaxis is not recommended due to the association of macrolides with pyloric stenosis. Monitor clinically and only test for chlamydia if symptoms develop.

B. Infants exposed to chlamydia at delivery have 50% risk acquiring chlamydia, therefore swabs and prophylactic treatment with PO erythromycin should be initiated

C. You should swab the infant, but only treat if the swab is positive.

Answer 125

A

Infants born either vaginally or by Caesarian section to mothers with an untreated chlamydia infection should be closely monitored for symptoms (eg, conjunctivitis, pneumonitis) and treated if infection occurs. Routine cultures should not be performed on asymptomatic infants.

Prophylaxis of exposed newborns is not recommended because of the association of macrolides with pyloric stenosis, but may be considered when infant follow-up cannot be guaranteed

Question 126

In a healthy infant, when/what is the first meningococcal vaccine they receive?

A) Men-C-C at 2 months

B) Men-C-ACYW at 6 months

C) Men-C-C at 12 months

D) 4CMen B at 12 months

E) Men-C-C in adolescence

Answer 126

Answer: C

Conjugated meningcococcal C vaccine at 12 months

Question 127

Choose all patients considered to be at increased risk for invansive meningococcal disease, thus requiring additional vaccine?

A) functional asplenia

B) HIV

C) complement deficiency

D) nephrotic syndrome

E) traveller to South America

Answer 127

Answer: A, B, C

Risk increased because of underlying medical conditions

• Asplenia or functional asplenia, including those with sickle cell anemia
• Properdin, factor D or complement deficiency (including those with acquired complement deficiency from eculizumab (Soliris); primary antibody deficiency
• HIV

Risk increased because of the potential for exposure

• Laboratory workers who work with meningococcus
• Military personnel living in close quarters
• Travellers to endemic areas (currently, travellers to sub-Saharan Africa and Hajj pilgrims)
• Close contacts of a case of IMD

Question 128

Which meningococcal vaccines are offered to children who are at increased risk for invasive meningococcal disease?

Answer 128

1. Men-C-ACYW (quadrivalent conjugated vaccines) e.g. Menveo, Menactra, Nimenrix
2. 4CMenB (meningococcal B vaccine) e.g. Bexsero

At the time of their medical diagnosis, if at least 2 months of age, even if Men-C-C has already been given

Question 129

Which of the following are risk factors for scabies?

1. Overcrowding (e.g. LTC, multigenerational homes, prison, childcare)
2. Poverty
3. Indigenous communities
4. Developmental delay

Answer 129

Answer - All of the above

• additional risk factors: immunocompromised, reduced access to healthcare, malnutrition, young & elderly

Question 130

How is scabies transmitted and what are some characteristic signs & symptoms?

1. Skin to skin; pruritic rash (worse at night) with predilection for flexural surfaces and folds
2. Via fomites; pruritic rash (worse at night) with predilection for flexural surfaces and folds
3. Skin to skin; pruritic scaly rash (worse at night) with predilection for extensor surfaces
4. Via fomites; pruritic scaly rash (worse at night) with predilection for extensor surfaces

Answer 130

Answer - A

Question 131

Choose all that apply in regards to the management of scabies:

1. Report to public health
2. Treat the patient and all symptomatic household members / contacts
3. first line treatment is with ivermectin
4. Children may return to school before completion of treatment
5. All bed linenes and clothing should be laundered in hot water and hot drier

Answer 131

Answer - 5

• all household members and contacts should be treated REGARDLESS of symptoms
• first line treatment are topical therpies, specifically 5% permethrin cream and should be repeated at least 7 days after first treatment. Ivermectin requires special access and could be considered in crusted scabies, outbreaks
• Children should only return to school AFTER compelting their initial treatment series
• if families do not have hot water, put all linen and clothing in sealed plastic bags & store for 5-7 days
• scabies is not a reportable disease

Question 132

What are some possible complications secondary to scabies?

Answer 132

1. Depression
2. Insomonia
3. Financial costs
4. Bacterial infection
5. PSGN & cardiac disease
6. Stigmitisation

Question 133

Antibiotic prophylaxis for UTI is recommended:

• a. For a child with recurrent UTIs
• b. To prevent sequalae such as chronic real failure from renal scarring
• c. Only in children with Gr IV, V reflux or sign urologic anomaly
• d. When child is found to have UTI with resistant organisms

Answer 133

c. Only in children with Gr IV, V reflux or sign urologic anomaly

info:

• if Gr IV or V VUR or significant urologic anomaly
  
  • Note large NNT needed. Note Abx resistance may soon negate potential benefits
• Use 3-6mo, then R/A. The longer the use, the more Abx resistance
• If used, use SDM with parents: risks and benefits discussion
• These cases should be discussed with Uro/Nephrology
• STOP if grows something resistant to the ABx, STOP altogether if grows things resis to both septra and NF

Question 134

Antibiotic prophylaxis in children:

1. Requires a NNT that ranges from 9 to 40 to prevent 1 UTI, as reported in large studies
2. Prevents renal scarring and their long term sequelae
3. Benefits outweigh the risk in most cases, therefore should be recommended to patient/parents
4. Results in increase resistance if agents such as Septra or Nitrofurantoin are used
5. Given as 1/2 of daily total dose given once daily

Answer 134

Answer: 1

1- correct

2- “Even if prophylaxis is effective, there is increasing doubt that recurrent UTIs in children with normal kidneys lead to long-term sequelae, even when such infections result in renal scarring.”

3- Risk outweigh benefits in most dt GI effects and resistance, and NNT is high, therefore only consider in Gr IV, V

4- Incr resistance with borad spectrum such as cefixime or cipro

5- Given as 1/4 to 1/3 of total daily dose

Question 135

What is false about oral thrush in neonates?

A) It may start as early as 7 days after birth

B) Colonization of the mother’s nipples in breastfed infants is a potential mode of transmission

C) Patients with severe or recurrent thrush should be investigated for congenital or acquired immune deficiency

D) Tx with oral nystatin 1-4ml (100, 000u/ml) every 6h for 7-14d

E) Nystatin is 80% effective after 2 weeks of treatment and should be given prior to feeding

Answer 135

E)

The usual dosage is highly effective, curing 80% of newborns after 2 weeks of treatment [5][11]. It should be administered after feeds.

Question 136

Factors associated with fatalities from over-the-counter cough and cold medications in children

1. Age younger than 3 years
2. Use of the medication for sedation
3. Use in a daycare setting
4. Combining two of more medications with the same ingredient
5. Failure to use a measuring device
6. Use of products intended for adult

Answer 136

Age younger than two years

Use of the medication for sedation

Use in a daycare setting

Combining two of more medications with the same ingredient

Failure to use a measuring device

Product misindentification

Use of products intended for adult

Question 137

At what age can children have over the counter cough and cold medications?

A. 2 years

B. 3 years

C. 4 years

D. 5 years

6. 6 years

Answer 137

Answer: depends who you ask lol!

Health Canada advised against the use of all CCM formulations in children younger than six years of age, with caution being exercised when these formulations were used in children older than six years of age [11]. The FDA recommended that CCMs should not be used in children younger than two years of age

Question 138

Which has been shown to have the most evidence to benefit children with coughs and colds?

A. Vitamin C

B. NSAIDS

C. Honey

D. Zinc

E. Humidified air

Answer 138

Answer: C honey

Several alternatives such as fluids, humidified air, NSAIDS, antihistamines, echinacea, zinc and vitamin C, have been investigated and, so far, show little benefit in the paediatric population. Honey may have beneficial effects, but dosing is yet to be determined.

Honey: potential benefit for cough and cold. Significantly superior to no treatment or honey-flavoured dextromethorphan for cough frequency and severity, bothersome nature of the cough, and the child/parent sleep quality. More recently, an RCT with 139 children (24 to 60 months of age) suffering from cough due to upper respiratory tract infection reported that 2.5 mL of honey before sleep improved cough frequency and severity, as well as sleep quality in a mean of 59% of children.

Question 139

5 year old has oral thrush. What is the most effective treatment?

A) Nystatin suspension

B) Clotrimazole troches

C) Clotrimazole vaginal cream applied to the oral mucosa after feedings

D) Oral fluconazole

Answer 139

B) clotrimazole troches

First-generation imidazoles, such as miconazole and clotrimazole, are more effective than nystatin. In children 3 years of age or older, mild disease or chronic oral candidiasis may be treated with clotrimazole troches (10 mg torches 5x daily x 7-10d). Miconazole gel is not licensed in Canada.

Second-generation imidazoles, such as oral fluconazole, may be considered if conventional topical treatments fail, or in moderate to severe cases. Although fluconazole is effective, it is not recommended for first-line management of thrush in immune-competent children because of limited paediatric data, potentially significant adverse effects, higher cost, and risk for promoting antifungal resistance.

Question 140

Which are true about the management of candida diaper dermatitis?

A) Treatment should include changing diapers frequently, and leaving diapers off for long periods of time

B) Topical antifungal such as miconazole ointment and clotrimazole cream are recommended

C) Low potency steroids (1%) can be used for refractory cases

D) Oral antifungals are not recommended in immunocompetent hosts

E) Antifungals are not recommended; first line therapy is zinc oxide

Answer 140

A) Treatment should include changing diapers frequently, and leaving diapers off for long periods of time - T

B) Topical antifungal such as miconazole ointment and clotrimazole cream are recommended - T

C) Low potency steroids (1%) can be used for refractory cases - False, no evidence and role of steroids unclear

D) Oral antifungals are not recommended in immunocompetent hosts - T

E) Antifungals are not recommended; first line therapy is zinc oxide - False, topical antifungal is recommended and more safe/effective than zinc oxide

Question 141

Which are false about tinea corporis/ringworm?

A) Transmitted by direct contact with infected humans, animals (usually dogs and cats) or by fomites

B) Treatment is topical antifungals 1-2x for 14-21d

C) It is the most common pediatric superficial dermatophyte infection

D) Any choice of clotrimazole, ketoconazole, miconazole, or terbinafine can be used as there is little difference in efficacy

Answer 141

C - the most common peds superficial dermatophyte infection is tina capitis

Question 142

Which antifungals are hepatoxcic?

A) Fluconazole

B) Clotrimazole

C) Itraconazole

D) Terbinafine

E) Nystatin

F) Ketoconazole

Answer 142

A, C, D, F - fluco, itraconazole, terbinafine, ketoconazole

Some experts recommend baseline, then periodic testing of transaminases, especially when a therapy course exceeding 4 to 6 weeks is anticipated

Ketoconazole was the first azole evaluated for efficacy in the treatment of resistant superficial fungal infections such as tinea capitis. In 2013, Health Canada released an advisory that ketoconazole had been associated with reports of serious hepatotoxicity and death. Ketoconazole is no longer recommended for the treatment of mild to moderate fungal infections.

* Tina capitis = terbinafine x 2-6 weeks

Question 143

What is false about tinea pedis?

A) Tinea pedis is most common in the population of young children

B) There is an increased risk for tinea pedis/onchomycosis in T21 and immunocompromised patients

C) It can be treated by topical antifungal lacquers for 4-8 wks

D) Tinea pedis spreads amount household members

Answer 143

A) Tinea pedis is the most common in young children - actually uncommon in young children

Question 144

Which ONE of the following statements is true re diagnostic assessment of ASD:

1. Guidelines recommend not exceeding 3-6month wait time
2. Dx in a child <2 can be made by an individual community paediatrician, an ASD practitioner or a multi-D team
3. If uncertain, a community paediatrician may make a provisional diagnosis and reassess in the future for certainty.
4. A team based approach is preferred for all diagnostic assessments

Answer 144

Answer: 1

1. Yes
2. “… or a child under 2 years of age, a paediatric care provider may use information from an ASD diagnostic assessment tool, and consult with another health care professional with specialized knowledge “
3. “A provisional diagnosis can be made, but the child must be monitored carefully, and referred for further, in-depth evaluation. In many jurisdictions, specialized ASD interventions are not available to children with a provisional diagnosis.”
4. “Emerging evidence that simple cases can be diagnosed by Solo MD”. “A ‘one-size-fits-all’ multi-d team approach is inefficient, and contributes to long wait times”

Question 145

4 categories of DDX or co-morbid conditions to consider in ASD Ax are:

1) Neurodevelopmental
2) Neurologic
3) Mental/Behavioral
4) Genetic

Name 1-2 conditions from each.

Answer 145

1) ND: ADHD, LD, GDD/ID, Tourettes, Social (Pragmatic) Communication Disorder
2) Neuro: CP, Epilepsy, Landau-Kleffner syndrome, Mitochondrial disorders, Neonatal encephalopathy
3) Mental/Behav: GAD, Conduct disorder, Oppositional, MD/Dep, OCD, Schizophrenia, Reactive attachment, Selective Mutism
4) Genetic: Fragile X, Rett

Question 146

A needs assessment intended for intervention planning for a child with ASD, will include evaluation of all of the following except one :

1. Speech, language, and communication skills
2. Sensory and motor functioning, and sensory sensitivities
3. Adaptive functioning (e.g., self-help skills)
4. Behavioural and emotional functioning (e.g., anxiety, self-esteem issues)
5. Family dynamics and attachment
6. Cognitive and academic functioning
7. Physical health and nutrition

Answer 146

5.

(it just isnt listed, the rest are)

Understanding overall levels of functioning in several domains, including strengths, skills, challenges, and needs, helps with developing effective, individualized treatment and management planning.

Such plans should also consider both individual and family concerns, priorities, and resources.

Question 147

Some diagnostic considerations when evaluating for ASD include all of the following except:

1. Difficult to diagnose <2yo, but not impossible, may be provisional at first
2. In females, presentation is more striking and therefore can lead to earlier diagnosis
3. children from racial or ethnic minorities are diagnosed later than their peers in the general population
4. Children living in rural or remote communities receive an ASD diagnosis later than peers living in urban areas

Answer 147

2.

Diagnostic Considerations

1. AGE: Difficult to diagnose <2yo, but not impossible, may be provisional at first
2. SEX: n females, presentation may be subtle or later diagnosed. M:F 4:1, likely underdiagnosed
3. ETHNICITY: children from racial or ethnic minorities are diagnosed later than their peers in the general population
4. REMOTE: Children living in rural or remote communities receive an ASD diagnosis later than peers living in urban areas

Question 148

Which of the following are appropriate ways to determine treatment goal weight for adolescent with anorexia nervosa? (pick all that apply)

A) TGW based on prior growth (weight, height, and BMI percentile)

B) TGW based on weight at same percentile as current height percentile

C) TGW based on median BMI for age

D) TGW based on menstrual threshold + at least 2 kg of weight

Answer 148

All of the above

• TGW based on prior growth (weight, height, and BMI percentile)
• TGW based on weight at same percentile as current height percentile
• TGW based on median BMI for age
• TGW based on menstrual threshold (some suggest 2 kg above this or higher)

Question 149

Which of the following is false about TGW in anorexia nervosa?

A) Should be reassesed every 3-6 months - recalculated periodically based on growth status and adjusted, and premised on overall health

B) Lowering the TGW can place a child or adolescent at risk for incomplete recovery

C) TGW is considered to be the ideal weight for overall health and growth

D) If there is a decline in height percentile, a bone age should be done to assess potential for future growth

Answer 149

A) Should be reassesed every 3-6 months - recalculated periodically based on growth status and adjusted, and premised on overall health

B) Lowering the TGW can place a child or adolescent at risk for incomplete recovery

C) TGW is considered to be the ideal weight for overall health and growth = FALSE. It is the minimum acceptable weight for overall health.

D) If there is a decline in height percentile, a bone age should be done to assess potential for future growth

Question 150

Chris is a 15.0-year-old male who was diagnosed with atypical AN. He presents with a weight of 57 kg (50th percentile) and height 174 cm (75th percentile). His growth curves (WHO) show that he has followed the 90th percentile for weight and 75th percentile for height until he was 13 years old. Thereafter, his mother reports that he began overeating and became inactive in the context of a depression. One year ago, his weight was 76 kg (97th percentile) and his height was 168 cm (75th percentile). He has been restricting his intake over the past year, resulting in a 19 kg weight loss and is now fearful of any weight gain.

What method of determining TGW has limitations in this scenario and that you should be cautious of using?

Answer 150

Determining the TGW using the mBMI calculation (50th percentile BMI for age and sex)

• In children and adolescents with premorbid histories of being at extreme ends of the BMI spectrum, or in cases of atypical AN (e.g., patients who meet all criteria for AN, except despite significant weight loss, their weight is within or above the normal range. May be better to use other methods like their TGW based on prior growth/curve he was following.

Question 151

True or false.

Infestation with lice reflects poor hygiene and is a vector for disease.

Answer 151

Answer - false

• Lice are not a primary health hazard, do not represent a sign of poor hazard and are not a vector for disease
• this needs to be re-enforced to famillies and the public

Question 152

True or false.

Diagnosis of head lice requires detection of a living louse and NOT a nit (egg).

Answer 152

Answer - True

• you require detection of a living louse to make a dx of head lice
• unfortunately nits can represent past infection and are not sufficicent alone to make diagnosis of active head lice

Question 153

Select all statements that are true:

1. Lice spread mainly through skin to skin contact
2. Transmission of lice also occurs through fomites
3. There are reports of increasing resistance with pyrethrins, permethrin and lindane
4. Misdiagnosis/over-diagnosis and reinfestation after previous tx are things that should be ruled out prior to labelling someone as failing treatment

Answer 153

Answer - 3 & 4

1. Lice spread mainly through skin to skin contact - FALSE, they spread mainly through head-to-head contact
2. Transmission of lice also occurs through fomites - FALSE; this is controversial.
3. There are reports of increasing resistance with pyrethrins, permethrin and lindane - TRUE
4. Misdiagnosis/over-diagnosis and reinfestation after previous tx are things that should be ruled out prior to labelling someone as failing treatment - TRUE

Question 154

Select all that are true:

1. Topical insecticides such as permethrin and pyrethrin are first line agents to treat lice
2. Topical insecticides do not require second application
3. Wet combing is an acceptable alternative therapy
4. Children who have lice or nits should not be excluded from school or child care
5. Environmental disinfection is required when there is lice infestation

Answer 154

Answer - 1 & 4

1. Topical insecticides such as permethrin and pyrethrin are first line agents to treat lice - TRUE
2. Topical insecticides do not require second application - FALSE, you require second application for insecticidal and non-insecticidal treatment
3. Wet combing is an acceptable alternative therapy - FALSE; little evidence to support wet combing as primary tx
4. Children who have lice or nits should not be excluded from school or child care - TRUE. Families should be alerted when a class is affected by lice and should be provided with credible information re: lice and management of it. Should emphasize to them that this does NOT reflect poor hygiene.
5. Environmental disinfection is required when there is lice infestation - FALSE. No medical evidence showing this decreases likelihood of reinfestation. It is reasonable to wash items that have been in close or prolonged contact with the scalp. Can consider washing in hot water and put in drier x 15 mins OR can put in plastic bag x 14 days

Question 155

The 2 dose schedule for HPV-9 vaccine is indicated in the following scenarios:

1. children aged 9-14 yoa
2. Immunocompromised hosts
3. Patient with HIV
4. Individuals aged 15 and above

Answer 155

Answer - 1

• all the other scenarios the patients require 3 doses
• doses need to be given at least 6 months apart

Question 156

Risk factors for HPV infection include (choose all that apply):

1. Higher lifetime of sexual partners (for patient and partner)
2. Previous STIs
3. History of sexual abuse
4. Early age of sexual intercourse
5. Tobacco or marijuana use
6. Immune suppression, HIV

Answer 156

Answer - all of the above

Question 157

All of the following are true EXCEPT:

1. HPV infection can range from being asymptomatic to genital warts and cancer
2. HPV vaccine has a good safety profile
3. the HPV vaccine is almost 100% efficacious in preventing type-specific cervical disease if given PRIOR to exposure (to that subtype)
4. Girls who receive the HPV vaccine are more likely to be sexually active, engage in riskier sexual behaviour, and increase rates of STIs

Answer 157

Answer - 4

Question 158

GDD diagnostic criteria includes significant delay (at least 2 SDs below the mean) in at least 2 of the following domains except:

1. Gross or fine motor
2. Speech/language
3. Cognition
4. Social/personal
5. School performance

Answer 158

5. School performance

GDD diagnostic criteria

Significant delay (at least 2 SDs below the mean) in at least 2 ofthe following:

1. Gross or fine motor
2. Speech/language
3. Cognition
4. Social/personal
5. ADLs

Question 159

GDD in children- pick incorrect choice (s):

1) Dx made under age of 6
2) Together with ID, affects 3% of population
3) Important to identify early for intervention and provision of genetic counselling
4) GDD diagnosis leads to ID diagnosis in adulthood

Answer 159

1, 4

GDD in children- pick incorrect choice (s):

1) Dx made under age of 6 –NOPE, Age 5
2) Together with ID, affects 3% of population - yes
3) Important to identify early for intervention and provision of genetic counselling- yes
4) GDD diagnosis leads to ID diagnosis in adulthood - NOPE, not necessarily

Question 160

Intell Disab - which is false

1) Level of severity of ID determind by IQ
2) Children with GDD often evolve to meet diagnostic criteria for ID
3) etiology of GDD/ID can be identified in many/majority of cases, depending on severity

Question 161

Causes of GDD ?

(3 categories (times of insults),

and subcategories of things)

Answer 161

Causes of GDD and ID:

1. Prenatal
   
   1. intrinsic:
      
      1. Genetic
      2. Metabolic
      3. CNS malformations
   2. ​extrinsic:
      
      1. Infections
      2. Toxin
2. Perinatal:
   
   1. Asphyxia
   2. Prematurity
   3. Neonatal complications
3. Postnatal:
   
   1. Neglect
   2. Infections
   3. Trauma

Question 163

What are the 8 A’s of Cannabis use cessation?

Answer 163

8As for Addressing Cannabis use with Adolescents:

• Assure pt privacy & confidentiality
• Ask about cannabis use after obtaining permission to do so
• Answer all questions & support healthy choices
• Assess impact of cannabis use by applying a screening tool
• Appraise patient willingness to change or reduce use
• Assist with specific goal setting & realistic time frame
• Arrange follow up within weeks & regularly thereafter
• Acknowledge parental needs & concerns when these arise

Question 164

What are digital media recomendations?

Answer 164

4 M’s:

• Manage screen time
• encourage meaningful screen time
• Model healthy screen time
• Monitor for signs of problematic behaviour

Question 165

How much sleep should average child get?

Answer 165

Healthy full term infant - 16-18 h/day

6 months - 14-15 h/day

1 year - 13-14 h/day

2-3 years - 12-13 h/day

5-6 years - 10-11 h/day

9 years+ - 9 h/day