2021 Flashcards
1
Q
Define Developmental Coordination Disorder?
A
DCD = common neurodevelopmental disorder
- Difficulties with learning gross or fine motor skills
- Low scores on standardized motor testing and a history of motor problems from the early developmental period
- Leading to functional impairment in academic achievement or ADLs
- RULE OUT = motor difficulties cannot be result of a medical condition like CP or visual impairment
2
Q
What is the DSM5 criteria for Developmental Coordination Disorder (DCD) and how do you test for it?
A
DSM5 Criteria and how to test:
- Acquisition and execution of coordinated motor skills substantially below expectation for child’s age and opportunities of motor skill learning (ie. clumsy, slow, inaccurate motor skills ex. with catching ball, using scissors, handwriting, bike riding, sports)
- OT or PT assessment of standard motor assessment (MABC-2 = Movement Assessment Battery for Children-2)
- Motor skills deficit significant and constantly interferes with ADLs for age and impacts school/leisure and play
- Hx and parent questionnaires like DCDQ (5-15yo) or Little DCDQ (3-4yo) to determine functional impact.
- scores are ‘indicative of DCD’, ‘suspect’ or ‘probably not’
- Onset of Sx in early developmental period
- developmental history focusing on difficulties in LEARNING motor skills, b/c usually meet motor milestones
- Motor skills deficit not better explained by ID, visual impairment, neuro conditions like CP, DMD, etc)
- ensure vision assessed
- neuro exam
- standardized IQ testing might be needed
3
Q
What are ‘soft’ neurological signs for DCD?
What are other clinical features to look for on exam?
A
Soft signs:
- non-specific markers of performance difference in age approp motor task (usually fade by age 6 but may persist in DCD)
- overflow movements (hands posturing when heel/toe walking)
- mirror movements (one hand copying other when imitating finger pattern)
- finger agnosia (visual monitoring to copy finger pattern when proprioceptive feedback not enough)
- coordination struggles (ie. trouble with finger-nose or rapid alt mvmt but normal Romberg)
- low-normal tone
- should NOT have ‘hard’ signs = hypertonia, true hypotonia, abnormal DTR, ataxia, spasticity, asymmetry)
4
Q
What are risk factors for DCD and co-occurring conditions?
A
Risk factors:
- male > female (2:1 to 7:1)
- preterm
Co-occurring conditions
- ADHD
- Autism
- specific LD
- language delays
- anxiety
- depression
5
Q
What are other things to test on exam when evaluating for DCD?
A
- neurocutaneous exam for NF1 or TS
- dysmorphism and growth concerns
- joint hypermobility (have be hypermobile esp hands/feet but no other EDS Sx)
- joint swelling (r/o JIA)
- joint pain
- posture
- spine exam
- Investigations (based on Hx/PE):
- Hearing/vision test
- CK
- metabolic panel
- TSH
- nerve conduction studies
- neuroimaging
- microarray, fragile X, karyotype
- Evaluate for co-occurring:
- ADHD, LD, ASD, anxiety/depression
6
Q
What are management aspects for DCD?
A
- Monitor for secondary sequelae (ie. obesity, sedentary, poor self-esteem, MH)
- Refer to OT/PT
- Task-specific interventions preferred (ex. Cognitive Orientation to Occupational Performance CO-OP)
- Encourage participation in individual, non-competitive sports
- CanChild website for resources
7
Q
Age of onset of FPIES
A
2-7 months
8
Q
Which has more severe presentation, FPIES or FPIAP?
A
FPIES
9
Q
How long after ingesting a trigger food do FPIES symptoms begin?
A
1-4 hrs
10
Q
How long after ingestion of trigger food does diarrhea begin in FPIES?
A
5-10 hours
11
Q
Hypothermia, hypotension, hypotonia, acidemia and methemoglobinemia are severe complications of FPIES
True or False?
A
True
12
Q
FPIES reactions include cutaneous and respiratory symptoms.
True or False?
A
False
13
Q
Age of onset of FPIAP
A
0-6 months
14
Q
Vomiting and diarrhea are part of FPIAP
True or False?
A
False
15
Q
Failure to thrive occurs with FPIAP
True or False?
A
False
16
Q
Physical exam of FPIAP
A
Normal
17
Q
Bloodwork findings in FPIES
A
leukocytosis, neutrophilia, thrombocytosis, methemoglobinemia, metabolic acidosis
18
Q
Top acute management priorities in FPIES
A
hydration - IV fluids
Ondansetron 0.15mg/kg
19
Q
Dose of ondansetron for
- < 15kg
- 15-30kg
- > 30kg
A
- 2mg
- 4m
- 8mg
20
Q
Kids with FPIES should avoid all foods that “may contain” their trigger food
True or False?
A
False
21
Q
Kids who have FPIES to milk should NOT avoid soy products once they’re > 6 months old
True or False
A
True
22
Q
Which other grain protein has a high level of cross-reactivity with rice?
A
oat
23
Q
What are the top 4 trigger foods for FPIAP?
A
cows milk, soy, egg, corn
24
Q
What are the top 4 trigger foods for FPIES?
A
Milk, soy, grains, egg
25
What are the top 2 meat triggers of FPIES?
Chicken, Turkey
26
What are the top 2 fruit triggers of FPIES?
banana, apple
27
What are the top 2 vegetable triggers of FPIES?
sweet potato, pea
28
What is the prognosis of FPIAP?
spontaneous resolution by age 1 year
29
What is the prognosis of FPIES?
Resolution:
## Footnote
35% spontaneous resolution by 2y/o, 70% by 3 y/o, 85% by 5 y/o
30
When can you trial re-introduction of a trigger food?
12-18 months after the most recent reaction
31
When do you refer to an allergist for FPIES?
for oral food challenge if trigger unclear, atypical symptom time course or lack of symptom resolution with trigger elimination
for oral food challenge when ready to reintroduce trigger foods
32
What are rescue meds used in procedural sedation?
**Rescue med****Dose range and route****Comments**Atropine0.02mg/kg IV (max 0.5mg)May repeat once (max 1mg/child; 3mg teen)Epinephrine (0.1 mg/mL)0.01mg/kg IV (max 1mg)May repeat q3-5minFlumazenil (benzo reversal)0.01mg/kg IV (max 0.2mg)
May repeat q1min to max cumulative 0.05mg/kg or 1mg total, whichever is less
Contraindicated in pt with seizure d/o
Naloxone (opioid reversal)0.1mg/kg IV (max 2mg)
Dilute + titrate to effect; may repeat q2-3min
Contraindicated in chronic opioid use
Succinylcholine
1-2mg/kg IV (max 150mg)
2-4mg/kg IM
Essential rescue med for severe laryngospasm and RSI
Repeat doses increase bradycardia risk
33
What are the ASA levels for anesthesia risk?
1. Healthy
2. Mild systemic disease
3. Severe systemic disease
4. Severe with life threat
5. Won’t live 24h with/without the procedure
34
What are the ASA fasting guidelines pre-procedure?
1h clear liquids, 4h human milk, 6hr formula/other milk/light meals
35
What are the recommendations prior to providing procedural sedation?
* Recommendations:
* Only do sedation if there is HCP present for airway and resus, extra HCP to do just sedation (and not also procedure), continuous monitoring, immediate emerg equipment, place to monitor post, including admission if needed
* Need to check ASA class 1 or 2, fasting status, informed consent, and refer to anesthesia if more complex
* Clinicians need approp skills and credentials, know indications/contrind and risk of meds, can manage pt at any depth of sedation and competent in resus and stabilization
* Develop institutional policies/procedures at hospital (with documentation, checklist and review process)
36
What are possible congenital complications associated with SSRI/SNRIs in pregnancy?
* Congenital malformations risk is controversial
* Some possible associations but absolute risk increase is small and some studies showed no risks
* Overall = **CHD** (TOF and Ebsteins), anorectal defects, gastroschisis, renal dysplasia, clubfoot if used in first trimester
* Sertraline = no association
* Citalopram = no association
* Paroxetine = anencephaly, ASD, RVOTO, gastroschisis, omphalocele;
* Fluoxetine = RVOTO, craniosynostosis
* Also some association with preterm birth and low birth weight (\<2500g)
37
What are common post-natal complications of SSRI/SNRI use in pregnancy?
* Most common is Poor Neonatal Adaptation Syndrome (PNAS) or NAS/serotonin discontinuation syndrome (in 30% of babies)
* Can have symptoms hours to 2 weeks post birth (usually mild/self-limiting)
* Poor tone, tremors, jitteriness, irritability, sz, poor feed/sleep, hypoglycemia, resp distress
* Modified Finnegan not validated for this
* Consider observing infants 24-48h post birth + eat/sleep/console, encourage BF, don’t need to taper/stop SSRI pre-birth
* Monitor for hypoglycemia, and if severe, may need antiepileptic, fluids or resp support
38
What is the causative triad for early childhood caries (ECC)? What are complications of ECC? What is the definition of severe ECC?
Triad of childhood caries:
* Cariogenic bacteria (usually Strep mutans)
* Fermentable carbs
* Host susceptibility (enamel integrity)
Complications: tooth loss, malocclusion, more caries into adolescence, low oral health
Severe-ECC = aggressive form of ECC classified by location, # of teeth and age; usually needs surgery under GA
39
What are medications used to assist with sleep in children?
Melatonin:
* Only medication shown to be safe and effective in children \> 2years
* Useful for delayed sleep phase and sleep onset assoc disorders
* positive effects for ADHD and autism
* 2.5 - 10mg
* Can have side effects = nightmares
40
What are factors that make Indigenous children higher risk for caries?
* Acquire S. mutans early (ie. less than 12 months vs usually acquire at 19-31 months)
* Earlier teeth eruption (new teeth more prone to caries)
* Teeth microbiome more likely to have S. mutans (due to poverty, overcrowding, family size, nutrition and other health behaviours)
* Parents with caries
* Prolonged bottle feed (if BF, then would be protective unless BF \>12 months)
* Sugary drinks/snacks
* Tobacco smoke
* GDM, obesity
41
What are prevention strategies for early childhood caries?
* Prenatal ECC prevention: maternal dental care, oral hygiene education, prenatal nutrition, fluoride toothpaste
* Fluoride: fluoride toothpaste BID (\<3yo brushed by adult w/ grain sized toothpaste; 3-6yo w/ pea-sized amount)
* Community water fluoridation only received by 2% of FN
* Topical fluoride w/ first tooth eruption helps prevent (doesn’t work once already cavity)
* Oral health education: more benefit if oral health education at first tooth eruption
* Community based strategies: promotion of traditional foods first and BF can be helpful
42
What are possible therapies for treatment of early childhood caries (ECC)?
* Therapies:
* Sealants – for pits and fissures, apply on primary molars at eruption (74% remain caries free), fluoride varnish q3-6m
* Minimally invasive restoration (glass ionomer etc) prevent caries progression (can be done by hygienists etc)
* Silver diamine fluoride – stops caries progression (turns it black/hard) biannually if high risk for progression
* GA repair – prevention etc way more cost effective, and less risk of GA/pain etc
43
What are recommendations for improving early childhood caries in Indigenous children?
* Promote changes to diet (less sugary foods), exclusive BF until 12 months
* Prenatal and early oral health education
* Discuss oral health at well child visits with caries risk assessment once first tooth eruption
* Community water fluoridation
* Fluoridated toothpaste BID (grain sized for \<3yo, pea sized for \>3yo)
* Fluoride varnish with first tooth and q3-6 months
* Silver diamine fluoride to prevent spread of caries and consider interim therapeutic restoration and sealants on primary molars
* Consider expanding dental therapists, dental hygienist and PCP roles in remote places (and train in culturally approp manner)
* Advocate for adequate dental workforce and increased representation of Indigenous people
* Support ECC research in Indigenous communities
44
What are signs and symptoms of adrenal suppression?
* Poor linear growth\*\*\* (in ~50%)
* Poor weight gain
* Anorexia
* Nausea/vomiting
* Malaise
* Weakness/fatigue
* Headache
* Abdominal pain
* Myalgias/arthralgias
* Psych symptoms
* Cushingoid features
* Adrenal crisis = hypotension, hypoglycemia, seizures, coma
45
What are the recommendations to reduce risk of adrenal suppression with steroid use?
* Use lowest effective dose of steroid possible
* Reassess dosing regularly
* Give steroids in the morning if possible
* Use once-daily dosing if possible
46
When should you consider screening for adrenal suppression in children with steroid use?
* Screen if symptomatic
* Screen in asymptomatic children if:
* \> 2 week use of systemic glucocorticoids
* \> 3 month use of high dose inhaled corticosteroids (\>500mcg Flovent daily)
* \> 1 month oral swallowed glucocorticoids (ie. budesonide for EoE)
* \> 3 months of inhaled corticoids of any dose if used with CYP3A4 inhibitors (ie clarithromycin, ketoconazole)
47
What are recommendations regarding glucocorticoid tapers?
Glucocorticoid tapers:
* Don't prevent adrenal suppression so no need for long tapers (outside of course of treatment)
* \< 1 month use = no taper
* 1 - 3 month use = 1 - 2 week taper
* 3 - 6 month use = 2 - 3 week taper
* 6+ month use = 3 - 4 week taper
* Watch for steroid withdrawal symptoms (can mimic adrenal suppression)
* If suspected, check AM cortisol level (to make sure not adrenal suppression) and if normal, taper more slowly
48
How do you confirm/screen for adrenal suppression (AS) post glucocorticoid use?
* In asymptomatic individuals:
* Screen with ***AM cortisol level*** (7-9am) before tapering below physiologic dosing (8mg/m2/day)
* Must be off steroids for 24-48hr before test, and must have normal sleep-wake cycles
* If cortisol \<100 nmol/L = diagnostic for AS
* If 100 - 275 nmol/L = possible AS
* Should do ***ACTH stim test*** for these patients or ***empiric GC treatment*** (ie stress dosing or daily physiologic dosing)
* \> 275 = normal
* If symptomatic, treat and consult endo
49
When do you give stress dosing in adrenal suppression?
* Adrenal crisis, severe illness/injury
* IV STAT dose, then divided q6h doses or infusion
* Major surgery
* Pre-op IV dose, then divided q6h doses or infusion
* Minor/ moderate surgery or GA procedure
* 3 days of steroids until Sx resolve
* Moderate illness (can't tolerate oral)
* IV/IM doses x 24 h then reassess to oral dosing, or consult endo if still can't tolerate oral
* Moderate/ severe illness and can't tolerate oral (PRE-ED)
* Teach parents IM administration
* Also for travel/camping
Daily physiologic dosing = Hydrocortisone at 8mg/m2/day and divide into BID/TID if pt symptomatic)
50
What are the vaping terms ‘ghosting’, ‘dripping’, ‘dosing' and ‘dabbing’?
* ‘Ghosting’ = keep aerosol in lungs to make it disappear
* ‘Dripping’ = leak liquid onto coil directly for stronger effects but higher risk of injury
* ‘Dabbing’ = heat high cannabis concentrated products to make aerosol
* ‘Dosing’ = consuming high amounts of nicotine when vaping
51
What are the adverse potential health effects of vaping?
* Pulmonary
* chronic cough, bronchitis, asthma exacerbation, decrease exercise tolerance
* Vaping associated lung injury (VALI) - sterile inflammatory pneumonitis from vaping aerosols
* Possible heart disease
* Unintentional injury/ingestion
* Burns to face and head, ocular injury
* Nicotine toxicity
* Substance use disorders
* Toxicity
* Withdrawal
* High THC Sx (paranoia, psychotic Sx)
* Mental health:
* MDD, GAD, bipolar, schizophrenia
52
What are screening tools used to discuss vaping with youth?
* S2BI (screening to brief intervention)
* Ask "In the past yr, how many times have you used a vape?”
* Then ask follow up about products/substances used, how they get it, motives/context, frequency, intensity and level of motivation to quit/cut down
* CRAFFT (Car-Relax-Alone-Forget-Family-Trouble)
53
What are the 5 A's of tobacco cessation?
* Ask (about use)
* Advise (to stop/risks/cut down)
* Assess (motivation to quit)
* Assist (give therapy options)
* Arrange (follow up)
54
What are options for therapy for nicotine replacement and vaping cessation?
* Behavioural therapy is always first line
* can also try harm reduction if pt not motivated on cutting down/quitting
* Pharmacologic
* Nicotine replacement therapy:
* Patch + short acting product for breakthrough cravings (gum, lozenge)
55
What are regulatory approaches that communities and governments can implement?
* Community:
* Educate teens about risks of vaping in curriculum and health initiatives
* Ban vaping in school
* Improve access to healthcare and counselling in kids
* Government/Regulatory bodies:
* Add vaping to existing smoking policies
* Limit sale to minors and regulate online sales
* Limit how close to school you can vape and buy products
* Ban all flavoured vapes
* Ban adds targeted towards youth
* Strengthen packaging with health warnings
* Childproof containers
* Cap nicotine doses to 20mg/mL and limit THC concentrations
* Ensure nicotine replacement therapy is free
* Tax vaping products and use money for regulation
* Support research on vaping
56
What is the most common trigger of asthma exacerbations?
viral URTI
57
What O2 sat is prognostic of higher morbidity & ED management failure in asthma??
\< 92%
58
What are the elements of a PRAM score?
Oxygen saturation
Suprasternal retractions
Scalene muscle contraction
Air entry
Wheezing
59
What pram scores are associated with mild, moderate and severe asthma exacerbations?
Mild = 0-3
Moderate = 4-7
Severe = 8+
60
What FEV1 values are associated with mild, moderate and severe asthma exacerbations?
Mild = 70-80%
Moderate = 50-70%
Severe = \< 50%
61
What is the dose of Salbutamol MDI for acute asthma exacerbation?
\< 20kg = 5puffs
\>20 kg = 10 puffs
62
What is the dose of ipatropium bromide for acute asthma exacerbation?
4 puffs x 3 doses q 20-30 min
can consider 8 puffs/dose if \>30 kg
63
When should systemic steroids be used in acute asthma exacerbation?
PRAM _\>_4
64
What are the systemic steroid options for acute asthma exacerbation? (include dosing)
* Dexamethasone PO 0.3-0.6mg/kg
* Prednisone PO 1-2mg/kg
* Methylpred IV 1-2mg/kg
* Hydrocortisone IV 5-8mg/kg
65
What are the treatment escalation options after back-to-backs and oral steroids in acute asthma exacerbation?
* **Mgso4 IV 40-75mg/kg over 20-30 minutes**
* indicated for incomplete response in first 1-2 hrs
* IV salbutamol 1mcg/kg/min starting dose
* Heliox - PICU, failed max therapy
* IV Aminophylline - PICU, failed max therapy
* NIV or HHFNC
* Intubation - absolute last line
66
What are admission criteria in acute asthma exacerbation?
Still requires O2
PRAM _\>_4 4-6hrs after steroids
SABA meeded \> q4h after 4-6h tx
67
Under what circumstances should ICS be prescribed after ED presentation for acute asthma exacerbation?
sx or waking due to asthma _\>_2x per month
Mod-severe exacerbation and required oral steroids within last 12 months
Preschoolers:
* persistent sx _\>_8 days/month
* mod-severe exacerbations requiring PO steroids at presentation
68
What are the side effects of ventolin?
tachycardia
hyperglycemia
hypokalemia
69
What is the effect of systemic steroids in acute asthma exacerbation?
reduce need for hospitalization, risk of relapse and facilitates earlier discharge
70
What are the side effects of MgSO4?
hypotension, bradycardia
71
At what dose of ICS is there a risk of adrenal suppression?
\>200-250 mcg/day over prolonged periods
72
what percentage of canadians have food allergies?
6%
73
Is breastfeeding recommended as food allergy prevention?
no. mixed data
74
What is associated with increased risk for developing cow's milk allergy?
delayed or irregular supplementation of BF with cow's milk
75
What are the NIAID guidelines regarding introduction of peanuts & eggs for infants?
* mild to moderate eczema - introduction at 6 months. without atopic risk factors - introduction in accordance with parental preference and cultural norms
76
Which opiate has the best evidence for use in pain control for children?
morphine
77
What is the bioavailability of orally administered morphine?
25-35%
78
How do you convert an IV dose of morphine to oral?
multiply dose x 3
79
How does tramadol work?
weak agonist at mu-opiate receptor, weak inhibitor of norepinephrine and serotonin reuptake
80
In what ethnicities is ultrarapid metabolism of codeine most likely to be a concern?
mediterranean countries, horn of africa and southern india
81
What are the benefits of PHDM?
fewer severe infections, less NEC, shorter stays in NICU, dose-dependent improvement in neurodevelopmental outcomes. improved tolerance, shorter time to full feeds
* short-term rate of weight gain and linear growth inferior to prems fed formula but long-term growth unaffected
82
What are donors screened for prior to being able to give PHDM?
seronegative for Hp B&C, HIV, T-cell leukemia virus, syphilis
83
Describe the process of pasteurization of PHDM
* processed using Holder pasteurization (62.5 C for 30 min) then cultured after
* if positive culture post-pasteurization - discarded
* milk transported frozen, thawed on site
84
What are the effects of pasteurization?
* deactivates bacteria and viruses (Eg. CMV)
* spore-forming *Bacillus* species known to survive pasteurization but are usually detected on culture post-pasteurization
* some protein content denatured
* folate and vitamin C degrade during pasteurization
* Decreases IgA
* decreases lactoferrin (binds iron required for growth by bacteria)
* Decreases lysozyme enzyme
85
If parents wish to participate in informal unpasteurized human donor milk sharing, what should you advise them?
* ensure that donors have tested negative for hepatitis B and C, HIV, HTLV, and syphilis, and are not at risk for ongoing exposure.
* They must also make sure that prospective donors are not using illegal drugs, cannabis, tobacco products, or alcohol [[45](https://cps.ca/en/documents/position/pasteurized-and-unpasteurized-donor-human-milk#ref45)].
* Donors should be in good health. They should not be taking any medications or supplements routinely, including herbs.
* Donors should temporarily discontinue milk donation while experiencing an inter-current illness.
Parents must be thoroughly informed about safe handling and storage practices for human milk. The flash heating technique [[45](https://cps.ca/en/documents/position/pasteurized-and-unpasteurized-donor-human-milk#ref45)], which has been shown to deactivate HIV [[60](https://cps.ca/en/documents/position/pasteurized-and-unpasteurized-donor-human-milk#ref60)], could be one harm reduction strategy if parents source UDHM. However, parents should be made aware that human milk treated in this way may not be as nutritionally complete
86
What are the CENTOR criteria?
1 - Exsudate or swollen tonsils
2 - tender or swollen anterior cervical lymph nodes
3 - fever
4 - no cough
87
At what CENTOR score do you do a throat swab?
_\>_ 3
88
What is the probability of GAS infection if CENTOR score is _\>_ 3?
32-56%
89
To what age range does the CENTOR score apply?
3-14 years
90
What is the gold standard test for GAS pharyngitis?
bacterial culture
91
What is the sensitivity and specificity of a GAS rapid antigen test?
Specificity 95%
Sensitivity 86%
92
What is the treatment of GAS pharyngitis? (non pen-allergic)
Penicillin V:
\< 27kg: 300mg PO 2-3x per day x 10d
\>27 kg: 600mg PO 2-3x per day x 10d
Amoxicillin:
50mg/kg PO DIE x 10d
93
What is the treatment of GAS pharyngitis? (pen allergic - anaphylactic)
Clarithromycin 7.5mg/kg/dose BID x 10d
Azithromycin 12mg/kg/day DIE x 5 days
Clindamycin 5-10mg/kg/dose Q6-8H x 10d
94
What is the treatment of GAS pharyngitis?
(penicillin hypersensitivity reaction)
Cephalexin 20mg/kg/dose BID x 10days
95
Within how many days of symptom onset does GAS pharyngitis need to be treated to prevent ARF & Suppurative complications?
9 days
96
Antibiotic treatment of GAS pharyngitis prevents post strep GN
true or false?
false
97
What are the risk factors for ARF?
children living in Canadian North, overcrowded housing conditions, indigenous and Pacific Islander children
98
What is the course of eradication therapy for GAS pharyngitis?
* 10-day course of amox-clav or clinda
* 10 days penicillin or amox with rifampin for final 4 days
99
Mobidity and mortality of children with CSE
10-20% morbidity (neuro disorder, hemodynamic instability, long term neuro deficits, cognitive impairment, behaviour challenges)
2-8% mortality
100
What is not part of the acute management of CSE
a) 100% O2
b) manually opening mouth to suction
c) normothermia
d) blood glucose
b. should suction but statement explicitly says not to “pry open mouth”.
ABC mgt: monitors; frequent hypoxia .: 100% O2; suction (do not pry mouth open); reposition; ominous signs are bradycardia, hypotension, poor perfusion; obtain BG
101
What is the correct dextrose dose in CSE for BG\<2.6?
a) 5 cc/kg D25
b) 2 cc/kg D25
c) 10 cc/kg D10
d) 2 cc/kg D10
b) 2 cc/kg D25 (OR 5 cc/kg D10)
102
When should you prioritize these 2nd line antiepileptics for CSE?
a) pheny/fospheny
b) phenobarb
c) keppra
d) valproate
e) pyridoxine (Vit B6)
a) no specific indications (remember not to mix pheny and fospheny. AVOID for toxic ingestion/drug withdrawal)
b) \<6mo, prolonged febrile, toxic ingestion/drug withdrawal
c) resp depression or hemodynamically compromised (b/c less side effects than above)
d) no specific indications
e) \<18 mo with ?undiagnosed metabolic disorder
103
7 Ps of adolescent sexual health assessment
partners, practices, protection (STIs), past history STI, prevention of pregnancy, permission (consent), personal (gender) identity
104
Teen considering pregnancy or not using protection, should ensure all these vaccines specifically except:
a) tetanus
b) MMR
c) Varicella
d) hepatitis B
a) tetanus
105
What are STI risk factors in teens?
poor/no condom use, partner w STI, new partner, \>2 partners/y, serial monogamy, no contraception or only non-barrier, IVDU, any drug use, previous STI, unsafe sex, sex workers/clients, survival sex, street involement, anonymous sex, sexual assault/abuse
106
True or false: a 13 year old can legally have consensual sex with a 16 year old
False.
\<12 none
12-13yo \<2y
14-15yo \<5y
16+yo any
107
Chlamydia/gonorrhea testing can be done via any of these routes except
a) first catch urine
b) urethral swab
c) serology
d) pharyngeal swab
c.
NAAT: first catch urine, urethral/cervical swab, vaginal swab
culture: pharyngeal swab (for oral sex), anal swab (for anal sex)
serology is only for syphilis, HIV, hepatitis
108
Postnatal red flags for CP include all of these except:
a) hand preference \<12mo
b) leg stiffness \<12mo
c) no sitting by 12 mo
e) delayed or asymmetric movement
f) fisting \>4mo
c. No sitting by 9 months
109
Define GMFCS I-V (only I and II are in CPS statement)
I: walk w/o limitations, difficulties with speed/balance/coordinating advanced skills
II: support on uneven surfaces, crowded areas, long distances
III: hand-held mobility device indoors, stairs with assistance, wheelchairs for long distance
IV: powered mobility in most settings, short distances walking with support
V: wheelchair all settings, limited in ability for antigravity head/trunk postures
110
what type of CP has highest risk of scoliosis?
a) spastic unilateral
b) hemiplegic
c) spastic bilateral
**Spastic Unilateral** (stroke/cerebral malformation): seizures and scoliosis
Hemiplegic (stroke/cerebral malformation): homonymous hemianopsia; hip dislocations
Spastic bilateral (preterm PVL): visual inferior field defects
111
what type of CP has highest risk of hip dislocations?
a) spastic unilateral
b) hemiplegic
c) spastic bilateral
Spastic Unilateral (stroke/cerebral malformation): seizures and scoliosis
**Hemiplegic** (stroke/cerebral malformation): homonymous hemianopsia; hip dislocations
Spastic bilateral (preterm PVL): visual inferior field defects
112
CP at higher risk of all except:
a) intellectual disability
b) autism
c) ADHD
a
113
Hip screening recommendations for CP?
clinical exam and XR for all GMFCS II+
114
risk of seizures for CP (any GMFCS level)
a) 1/10
b) 1/5
c) ¼
d) ½
c.
highest risk with spastic unilateral CP
115
what are the ages for these early literacy milestones?
a) distinguish native languages
b) noun to object connections
c) robust understanding of common words
d) better language meaning comprehension
e) first 2 word phrases
a) 4 mo
b) 6 mo
c) 11-12 mo
d) 12-20 mo
e) 2yo
116
Risk factors for neonatal brachial plexus palsy:
excessive downward traction after delivery of head with shoulder dystocia; injury in utero or during descent; injury at time of expulsion; maternal diabetes; forceps/vaccum; episiotomy; fetal/birth asphyxia; LGA (\>4.5kg)
117
What are the nerve roots for these brachial plexus injuries?
a) Classic Erb
b) Extended Erb
c) total palsy w/o Horner
d) total palsy with Horner
a) C5 or 6
b) C 5-7
c) C5-T1
d) C5-T1 + sympathetic chains
118
# define these types of nerve injury and time to recovery
a) neuropraxia
b) axonotmesis
c) neurotmesis
a) temporary conduction block 2o myelin interruption, healing weeks
b) nerve fibre/myelin disruption, months-no recovery
c) nerve disruption, avulsion nerve roots, no recovery
119
Brachial plexus injuries
a) when to image?
b) When to refer brachial plexus injury to multiD team?
a) CXR and humeral XR only if concern for bony injury
b) incomplete recovery at 1mo
120
Who are high risk for influenza infections?
* 6mo-5yo
* chronic health conditions (cardiac/resp/renal/neuro/neurodevelopmental disorders, DM, cancer/immunocompromised, anemia/Hb-opathy, morbid obesity, prolonged ASA)
* Indigenous
* chronic care facilities
* pregnant
* 65+yo
* capable of transmitting to HR individual (household contacts of above groups or baby \<6mo, those providing care to kids \<5yo, HCPs)
121
Contraindications for influenza vaccine include all except:
a) egg allergy
b) anaphylaxis to prior flu vaccine
c) guillan barre within 6 month of prior vaccine
a. No longer any restriction for egg allergy
122
Who should get IIV vs LAIV flu vaccine?
All children \>6mo: IIV
2+yo immunocompetent: IIV or LAIV
pregnant: IIV
123
A baby is born at 26 WGA, BW 900g. At 20 mins of life, requiring CPAP 6, FiO2 28%. Which is true about surfactant therapy?
A Surfactant increases the incidence of air leak in RDS
B. Exogenous surfactant inhibits endogenous surfactant production, so CPAP is trialled first.
C. Administration of surfactant improves arterial oxygenation
D. Surfactant administration reduces the incidence of BPD.
Answer: C - Surfactant is beneficial in the SHORT term.
**Surfactant**:
* improves oxygenation
* decreases mortality
* decreases risk of PTX (but ensure **volume-controlled ventilation** so no PTX following administration)
* decreases duration of ventilatory support
* decreases length of NICU stay
Surfactant does NOT affect rates of **BPD**, NEC, IVH, or ROP.
124
Based on the updated CPS statement on surfactant administration for RDS, what is the main indication for giving exogenous surfactant?
Exogenous surfactant (animal-derived \> synthetic) is given to kids with RDS who are demonstrating increasing severity of RDS, objectively based on **FiO2 \> 50%**.
Surfactant can be repeated if ongoing moderate-severe RDS, ie **FiO2 \>40%.** Doses usually repeated as early as 2h, usually in 4-6h. Max 3 doses.
125
What are 5 ways that we can prevent or treat RDS?
_Prevention_:
* Antenatal steroids to mom if \<35 WGA and at risk of delivery within 7 days
* Transfer moms \<32 WGA to a level 3 NICU, so ideally babies are born there. Transfer baby if outborn \<32 WGA
_Treatment_
* NIPPV (CPAP or BiPAP) should be given from birth
* Volume-targeted ventilation
* Early surfactant if FiO2 \>50%. Repeat if FiO2 \>40% in as early as 2h, generally after 4-6h. Max 3 doses
* Early extubation to CPAP following surfactant administration
* Give intubated infants with RDS surfactant prior to inter-facility transfer
