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Flashcards in CPS statement volume 3 Deck (56)
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1

Which of the following is the definition for fever of unknown origin?
a) fever lasting >14 days with no aetiology found after routine tests
b)fever lasting >21 days with no aetiology found after routine tests
c)fever lasting >10 days with no aetiology found after routine tests
d)fever lasting >30 days with no aetiology found after routine tests

a) is the answer
depends on precise temperature recordings

normal body temperature 37 degrees, fever generally accepted to be >38 core temperature

2

Which of the following methods of temperature measurement is the gold standard?
a) axillary
b) rectal
c) oral
d)tympanic

b) is the gold standard

3

Which of the following is not a limitation of rectal thermometry?
a) slow to change with changing core temperature
b)stays elevated after the core temperature has started to resolve
c) more expensive than other methods
d)affected by depth of measurement
e)affected by local blood flow
f) risk of spreading infection

c)

the others are limitations
also lots of parents not comfortable with it and older infants may not like it.

4

Which of the following about axillary temperature readings is true?
a) good specificity
b) good sensitivity
c) accurate readings in children
d) depends on environmental conditions

d)

low sensitivity and specifity, inaccurate readings in children, AAP still recommends it as a screening test in neonates because of risk of rectal perforation (even though this risk is 1/1-2 million). measures temperature over the axillary artery.

5

In which of the following patients is one likely to obtain a reasonable reading with an oral thermometer?
a) unconscious 12 year old in ER
b) 4 months old baby
c) 5 year old autistic boy unable to obey commands
d) 14 year old with a sore throat

d)

oral's accuracy is generally though to be between rectal and axillary, improves with age of child.
does require significant cooperation to get the temperature above the lingual artery
need to keep mouth sealed with tongue depressed for 3-4 minutes
can't use in young children or in unconscious or uncooperative patients, influenced by recent food/drink ingestion or mouth breathing.
we now use digital thermometers instead of mercury thermometers.

6

Which of the following is not true of current tympanic thermometry?
a)are not in direct contact with the tympanic membrane
b)crying, otitis media and earwax can influence the accuracy of the reading
c) the blood supply to the TM is very similar to the blood around the hypothalamus
d) measures the thermal radiation emitted from the TM and the ear canal (infrared radiation emission detectors)

b)
these have been shown to NOT influence accuracy
initially TM thermometers were in direct contact, now they are not, they work with the radiation detectors

controversial, 60-70% of practioners use it, but those who stopped using it usually quoted inaccuracy or lack of trust as the reason.

7

Which of the following factors does not contribute to the variability of ear based temperature measurements?
a)difference in brands in terms of operation and technology
b) infrared probe too large to be inserted into the meatus to obtain an orientation with the TM
c) risk of tympanic perforation
d)how well the canal is sealed from ambient influences

c)

the others contribute to variability
often probe is too big in kids

8

Which of the following statements is false?
a) pacifier thermometers are a great option for infants in respiratory distress
b) temporal thermometer might be a promising screening tool for low risk children in the ER
c) temporal thermometer was found to have a sensitivity 80% to identify fever in a recent study in a paediatric ER
d) parental use of temporal thermometers did not result in good correlation with rectal readings

a) not great for these infants, also less accurate than rectal thermometer

cut off 37.7 then sensitivity increased to 90% (but specificity to 50%)

9

Which of the following patients does not have a fever?
a) 12 year old with axillary temperature of 37.8 C
b) 2 month old with rectal temperature of 38.1 C
c) 10 year old with tympanic temperature of 37.6
d) 4 year old with oral temperature of 37.6

c) is the answer

normal temperature ranges for different methods of measurement

rectal - 36.6-38
ear - 35.8-38
oral - 35.5-37.5
axillary - 34.7-37.3

10

Which of the following is not the ideal method for measurement in the patient listed?
a) birth - 2 years - rectal (definitive), axillary (screening)
b) 2-5 years - rectal (definitive), axillary, tympanic (screening), temporal artery (if in hospital for screening)
c) 2-5 years - oral (definitive), axillary, tympanic (screening), temporal artery (if in hospital for screening)
d) >5 years - oral (definitive), axillary, tympanic (screening), temporal artery (if in hospital for screening)

C) is the answer

11

Which of the following statements is false?
a) over 76000 children are in foster care in Canada
b) there are practice guidelines to meet the needs of children and youth in foster care
c) child welfare services operate under provincial and territorial jurisdictions
d) the federal government is responsible for children with First Nations status

b) there are no practice guidelines, most physicians will encounter children in foster care in their offices

foster care - not with bio parents, can be permanent or temporary, governed by a child welfare agency, lots of reasons for it, for Aboriginal from remote community can be to help get access to services

12

Which of the following is false?
a) 40% of Aboriginal children are in care
b) over 40% of foster children are Aboriginal
c) up to 68% of foster children in Manitoba
d) Jordan's law is a child's first principle that ensures the need of child are met by the government of first contact until jurisdictional dispute is resolved

a) 6% of Aboriginal children are in care


the rest are two, Jordan's law is for cases where the federal and provincial government can't decide who should pay the bill

13

Which of the following is true
A) Provincial laws govern issues of consent for treatment
b) All Canadian provinces are governed by the Criminal code of Canada for issues of child maltreatment
c) it is the physician's role to obtain documentation of past medical history including medications, allergies and immunization records
d) the child protection worker

a) true

Quebec is not governed by the Criminal code of Canada for issues of child maltreatment - rather Quebec civil code and Youth Protection act

c) child welfare worker has this responsibility, also to get consent for transfer of medical charts

14

Which of the following is not part of the AAP guidelines for health supervision in foster care?
a screening for mental health
b screening for STIs
c follow up within 30 days
d initial medical visit within 36 hours

d initial medical visit within 24 hours

routine screen for development, mental health, dental health and STIs

15

In the 2003 Canadian incidence study on child maltreatment and neglect, how many investigated children had a learning disability?
a) 5%
b) 10%
c) 15%
d) 25%

c) 15% had a learning disability

10% had developmental delays
3% had substance abuse related birth defect
2% physical disability

16

IN the 2003 Canadian study on child maltreatment and neglect, how many investigated children had a behavioural concern?
a) 25%
b) 40%
c) 45%
d) 50%

b) 40% had at least one behavioural functioning issue
13% poor school attendance, ADHD, negative peer involvement

in comparason, national ADHD rates is 8-10% in males and 3-4% in females

17

Which of the following is not noted to be more common in Canadian foster children?
a) respiratory distress
b) opthalmological conditions
c) dermatological conditions
d) cardiac abnormalities
e) cerebral palsy
f) dental neglect
g) academic delays

d) not associated
study of foster children in urban Canada
resp - 19.3%
optho - 6.3%
derm- 16%

increased chronic health conditions such as cerebral palsy, asthma, congenital abnormality
2004 Ontario Crown Ward Review, 82% of Foster children has special needs
dental neglect, also craniofacial injuries (1/2 of children who were abused)

18

Which of the following is not part of the first health care visit for a foster child?
a) screen for and treat health conditions that need prompt assessment
b) assess need for vision and hearing screening
c) assess need for dental screening
d)routine bloodwork

d) should assess need for the following blood work on a case by case basis (shouldn't simply order routinely) : CBC, ferritin, lead, HIV, hepB and C, b- hCG, STI screen, Pap smear

follow up visit - immunizations (may be missing immunizations more), health review, including development and mental health, evaluate need for psyched assessment
should be monitored more closely than other children

19

Secondary enuresis is when there is incontinence after how many months of continence?
a) 3 months
b) 4 months
c) 6 months
d)12 months

c) 6 months
primary is when there is never been continence

enuresis is wetting >2 x/week beyond the age of five years

20

What percentage of 8 year old children have primary nocturnal enuresis?
a) 6-8%
b) 10-15%
c) 15-20%
d)1-2 %

a) is the answer

5 year old: 10-15%
15 year old : 1-2%

more common in boys



21

Which of the following about time out is true?
a) time out is most effective in 1-3 year olds
b) time out should last 1 minute for each year of child's age until 10 minute maximum
c) child should get ignored during time out
d) after the time out, parent should re-lecture the child on what they did wrong
e)time out should eliminate the unwanted behaviour

c) true, also make sure no secondary gains (i.e. TV)

the rest are false

a) false, from age 2 to the primary school years, should be introduced by age 24 months
should last 1 minute for each year of the child's age until 5 minute maximum, might be too long for age (be kid specific)
d) after time out, move on; before it prepare the child by briefly helping him connect the behaviour with time out - i.e. "no hitting"
e) may not eliminate the behaviour, but should decrease the frequency
if time out does not work after repeated tries, a consult is recommended

22

Which of the following is not associated with primary nocturnal enuresis?
a) should only treat if causing problems for the child
b) gene on chromosome 13q
c) family history
d) high probability of UTI

d) false , low pretest probability of true positive result, should be judicious with UTI testing since consequences of false positive result, the rest are true

**enuresis beyond age 10 can have consequences of poor self-concept

23

Which of the following is true of enuresis alarms?
a) goes off when starts to void
b) most effective in children 5 and under
c)there is a risk of buzzer burns and shock
d) usually see improvement within 3 weeks

a) true

b) most effective in children older than 7-8 years
c) this happened with older alarms, goes off with first few drops
works dependant on child and parents being motivated
d) need 1-2 months to see improvement, initial therapeutic trial should be continued for 3-4 months, initial improvement is often a decrease in urine output rather than totally dry night

24

Which of the following is not a common risk of homeopathy?
a) significant concerns about their safety
b) may not properly refer children for conventional medical care
c) may delay seeking medical attention while waiting for homeopathy to work
d) negative attitude towards vaccines

a) not a lot of major concerns about the safety of the drugs

25

Which of the following has been shown in studies of homeopathy?
a) numerous good quality RCTs
b) some evidence of statically significant benefit of homeopathy
c) little influence of publication bias
d) belief of individual will influence interpretation of the results

b) true, not the greatest study but true

a) nope, need more standardized studies
c) quite a bit of publication bias

26

Which of the following is true about desmopressin acetate?
a) should be used with extreme caution in children with cystic fibrosis
b) water intoxication is an common side effect
c) should avoid consuming fluids for 4 hours before and after
d) is commonly used to achieve a cure for nocturnal enuresis

a) true use with extreme caution in CF and in patients with trouble with osmoregulation and fluid balance


b) side effects (usually mild) can include headaches and abdominal pain, as well as nasal stuffiness and epistaxis for the nasal preparation. water intoxication is uncommon in the current literature.
c) avoid fluids 1 hr before and 8 hours after taking desmopressin
d) best for short term use (camp, sleepovers) rather than to achieve a cure

Cochrane review: 1-2 fewer nights per week of enuresis and twice likelihood of being completely dry (compared to placebo). cure rates after stopping the meds was same as placebo however. dose 200-600 ug.

27

Which of the following statements is false about imipramine hydrochloride?
a) maximum effect within one week of treatment
b) response rate and cure rate similar to desmopressin acetate
c) can adjust dose within days of starting the medication
d) risk of serious side effects including convulsions and cardiac arrythmias

c) false - should not adjust until 2 week therapeutic trial complete

minor side effects common - personality changes (emotional lability, irritability, anxiety), disturbed sleep patterns, h/a, changes in appetite.

probably of accidental overdose - should use with extreme caution (rare to get these side effects but need to be very very careful), cheaper than desmopressin

can use with caution for short term treatment with older children who are very distressed if parents are judged to be reliable and if parents are counselled about safe storage of medication.

28

What percentage of 8 year old children have primary nocturnal enuresis?
a) 6-8%
b) 10-15%
c) 15-20%
d)1-2 %

a) is the answer

5 year old: 10-15%
15 year old : 1-2%


29

Which of the following about primary nocturnal enuresis is false?
a) more common in boys
b) influenced by emotional and behavioural concerns
c) may be associated with deep sleep
d) variation of normal bladder control development

b) false, primary is not influenced by these but might affect treatment outcomes

30

Which of the following is not associated with primary nocturnal enuresis?
a)
b) gene on chromosome 13q
c) family history
d) high probability of UTI

d) false