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*CPS Statements TD > Community + Thoracic+Digital > Flashcards

Community + Thoracic+Digital Flashcards

(57 cards)

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1
Q

Neonatal hearing loss - most is sensorineural or conductive?

A

Sensorineural

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2
Q

Risk factors for neonatal SNL?

A
  • FHx permanent hearing loss
  • Craniofacial abnormalities incl those involving external ear
  • Congenital infections (inc back meningitis, CMV, toxoplamosisi, rubella, herpes, syphilis)
  • Physical exam findings consistent w underlying syndrome assoc w hearing loss
  • NICU >2 days or any of the following (regardless of LOS):
  • -ECMO
  • -assisted ventilation
  • -ototoxic drug use
  • -hyperbilirubinemia req exchange transfusion
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3
Q

How to test hearing in newborn?

A

OAE in everyone

ABR if do not pass OAE or any risk factors

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4
Q

What is missed on newborn screening?

A

Less severe congenital hearing loss (<30 dB)

Progressive or late onset hearing impairment (ex CMV)

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5
Q

Criteria for Functional Constipation?

A

At least 1x/week for at least 2 months
Need 2 or more in a child with a developmental age of at least 4 years
1. Two or fewer defecations in the toilet per week.
2. At least one episode of fecal incontinence per week.
3. History of retentive posturing or excessive volitional stool retention. 4. History of painful or hard bowel movements.
5. Presence of a large fecal mass in the rectum.
6. History of large diameter stools that may obstruct the toilet.

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6
Q

What are the common times for children to develop functional constipation?

A

Transition periods - children are prone:
Toilet training
Start of school

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7
Q

Definition of constipation

A

large hard mass in the abdo or dilated vault filled w stool on rectal examination, often substantiated by a hx of overflow incontinence

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8
Q

Risk factors for positional plagiocephaly

A

Male sex
Firstborn
limited passive neck rotation at birth (congenital torticollis)
supine sleeping position
only bottle feeding
awake ‘tummy time’ fewer than three times per day
lower activity level with slower achievement of milestones
Sleeping with the head to the same side and positional preference when sleeping

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9
Q

Signs of craniosynysotisis?

A

Often have ridging of the affected suture
Ipsilateral occipitomastoid bossing with posterior displacement of the ear
PP: ipsilateral anterior displacement of the ear

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10
Q

Primary nocturnal eneuresis

  • how often
  • age
A

> 2x/week

>5yo

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11
Q

Military children - issues

A
  1. Mobility
  2. Separation
  3. Risk
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12
Q

Risk factors for coping difficulties in military family children

A

–Younger parent age
–Young children
–Family member with prior mental health issues
–Children with special needs
–Child with preexisting behavioral issues
–Spouse with English as second language

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13
Q

What are some issues with housing in Canada?

A

–Infestations
–Poor water and air quality
–Unsafe neighborhoods
–Unstable housing (> 3 moves in child’s life)
–Inaccessibility for those with disability

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14
Q

What are health impacts of housing needs?

A

More aggressive behaviour
Property offenses
Poorer school performance
More asthma symptoms
Lower overall health
Easier spread of infxn and more psychological distress in crowded housing
Food insecurity – as a result of high housing cost
Inaccessible housing (for special needs)
lowers self esteem & can lead to more accidental injuries
Exposure to environmental hazards
Infestations à allergic reactions and secondary infections, worsening asthma, anxiety
Unsafe or no water supply (First Nations)
Unsafe neighbourhoods
More anxiety, Less physical activity

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15
Q

Who is at greatest risk for housing needs?

A

Aboriginal families,
Recent immigrants,
single-parent families
those with developmental, mental health, or physical disabilities

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16
Q

How to assess about housing needs?

A

Harm (in need of repair?)
Occupancy (How many ppl)
Moves (How often move, use of shelter)
Enough/Income (Enough for house, food, utilities?)

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17
Q

Who to treat w prophylactic Abx for UTI?
What abs, dosing?
Length?
What if resistant?

A

Grade 4-5 VUR
Trimethoprim/sulfamethoxazole or nitrofurantoin
one-quarter to one-third of the daily total treatment dose
3-6 months

If resistant to TMP-SMP AND nitro, no abx at all because resistance

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18
Q

UTI

  • what to look for on U/A
  • Urine culture count
A

nitrite, Leuk esterase, microscopy WBC (>10/hpf)

UCx
Clean catch - >10^5 CFU/mL
I&O - >5*10^4 CFU/mL
SPA - any growth

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19
Q

Bugs for UTI?

A 
E. coli
Klebsiella pneumoniae
Enterobacter sp.
Citrobacter sp.
Serratiasp.
Staph saprophyticus (female teens only)
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20
Q

Treatment for UTI

Abx
Duration

A

PO = IV for UTI/Pyelonephritis
If < 3mo - Prefer initial IV

PO amox, clavulin, Cefixime

Gentamicin IV +/- Ampicillin
Cefotaxime or Ceftriaxone IV

UTI - Treat 7-10 days
Afebrile UTI (cytitis) - 2-4 day course PO Abx
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21
Q

Signs of complicated UTI

A 
Hemodynamically unstable
High serum Cr
Abdo mass
Poor urine flow
No clinical improvement 24h post Abx
Fever not coming down 48h post Abx
* Use IV antibiotics
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22
Q

Imaging in UTI

A

Renal U/S for children < 2 years with first febrile UTI
During or within 2 weeks of illness
Detects hydronephrosis

VCUG – best way to diagnose VUR
ONLY if RUS suggestive of issues
In children < 2 years with 2 documented UTIs
Perform after antibiotics completed
Use of prophylactic Abx before procedure is controversial

DMSA
Can diagnose acute Pyelonephritis and renal scarring (later)
Radiation and unlikely to alter management
Only do if Dx of UTI is in question

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23
Q

What drugs are contraindicated in breastfeeding?

Study These Flashcards
A

Antimetabolites
Radioactive drugs
Drugs of abuse

24
Q

How long should infants breastfeed

Study These Flashcards
A

2 years and beyond

exclusive breast-feeding for the first 6 months

25
Most common chronic condition in children?
tooth decay
26
Most common surgery in children
dental
27
What is the most common bug in dental caries
Strep mutans
28
Who is at higher risk of dental issues?
Low SES aboriginal new Canadians complex care pts
29
ADHD - prevalence - life issues
1/20 Reduced quality of life Increased risk of injuries Behaviour problems Academic and social difficulties
30
Considerations with starting ADHD meds
adherence stigma school storage of drugs pharmacokinetic profiles
31
What type of meds are recommended for ADHD
Extended release more effective and equally efficacious as IR less risk diversion
32
Early vision screening helps prevent
decreases prevalence of amblyopia
33
Amblyopia
= reduced vision in absence of ocular disease – brain doesn’t recognize input Causes = strabismus, difference in refractive error
34
Refractive error
= inability to eye to focus on image - correctible with lens
35
Strabismus
= misalignment of eye
36
Visual Development Landmarjs
Birth - 4 mo - face follow 3 months - visual follow 42 months (3.5 years) - visual acuity measurable
37
What are screening tests for vision
* Red reflex * Corneal light reflex – central position of light on each eye * Fundoscopy * Cover-uncover test = strabismus
38
Screening vision by age?
Newborn to 3 months" - Complete exam of skin, external eye - Check red reflex 6 – 12 months: - Same exam - Ocular alignment test (cover-uncover test; corneal light reflex) - Fixation and following of a target 3 – 5 years - Same exam - Visual acuity 6 – 18 years As above every routine visit + complaints
39
two common causes of amblyopia
Strabismus | Difference in refractive error
40
What does cover uncover test tell you
strabismus
41
Contraindications to flying?
- Contraindications for flight - Uncontrolled hypertension - Uncontrolled SVT - Eisenmenger’s syndrome
42
What condition has there been some benefit with homeopathy
Diarrhea
43
What are concerns with using homeopathy
- reluctance on the part of those who practice homeopathy to support vaccinations - delays in seeking conventional medical therapies while waiting for results from homeopathic treatments may jeopardize the child’s health.
44
Pacifiers: | Pros and Cons?
``` Cons: May be related to early wean from BF Risk factor for otitis media Issue w dentition past 2 years Fomite - infection ``` ``` Pros May be protective against SIDS - but not enough ev to recommend Analgesia Good for Prems: Non-nutritive sucking, Comfort, Oromotor skills development, Better weight gain, Less NEC, Earlier discharge from hospital ```
45
Signs of a child’s toilet learning readiness
- Able to walk to the potty chair (or adapted toilet seat) - Stable while sitting on the potty (or adapted toilet seat) - Able to remain dry for several hours - Receptive language skills allow the child to follow simple (one- and two-step) commands - Expressive language skills permit the child to communicate the need to use the potty (or adapted toilet seat) with words or reproducible gestures - Desire to please based on positive relationship with caregivers - Desire for independence, and control of bladder and bowel function
46
When do most children obtain continence
24-48 months reflex sphincter control by 18mo
47
Head lice 1st line 2nd line
Pyrethrins (R&C) & permethrin 1% 2nd line: Isopropyl myrisate = Resultz; not for <4years Dimeticone solution
48
Higher incidence of flat foot
wearing shoes early in childhood, overweight, more flexible ligaments
49
Sleep hygiene
``` Stable bedtime and wake time Dark quiet space Avoid hunger (an excessive eating) before bed Relaxation techniques before bed Avoid caffeine, alcohol, nicotine Avoid screen time before bed ```
50
Risk factors for SIDS
``` Male, premature, LBW babies, low SES Aboriginal babies **Prone sleeping **Maternal smoking during pregnancy ``` ** Modifiable
51
Risk reduction for SIDS
- Place on back to sleep (supine) - Eliminate smoke exposure (Both during pregnancy and after) - Only sleep in crib/cradle/bassinet (No soft sleeping surfaces) - Avoid overheating - Do not leave to sleep in car seats, strollers, swings, etc. - Room sharing for first 6 months (NOT bed sharing) - Breastfeeding - Pacifier use while falling asleep
52
when to screen for: chlamydia/gonorrhea HIV Pap
chlamydia/gonorrhea: all sexually active HIV: all sexually active > 15yo Pap: >21yo
53
How should children ride in car?
Rear-facing car seats: 0-1 year and/or weigh <10 kg (22 lb). Forward-facing car seats: 10-18 kg (22-40 lb) and > 12 month Belt-positioning booster seat and use the vehicle’s lap-shoulder seat belt: >18kg/40lb AND >4 yo Vehicle seat belt system: > 145 cm (4’ 9”) tall or 9 years of age Back seat until 13 yo
54
Dx of asthma in preschooler
``` Airway obstruction (doc. wheeze) Reversibility (doc. improvement in airflow w SABA +/- steroid or course of ICS) No clinical evidence of alternative dx ```
55
Categories for PRAM score
``` O2 sat Suprasternal retraction Scalene muscle contracton Air entry Wheezing ```
56
Limits for screen time?
< 2yo: no screen time 2-5yo: <1 h/day >5yo: <2h/day
57
How to deal with screen use?
MANAGE screen time Encourage MEANINGFUL screen use MODEL Healthy screen use MONITOR for signs of problematic screen use

*CPS Statements TD (17 decks)

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