CPS statement volume 3 Flashcards Preview

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Flashcards in CPS statement volume 3 Deck (56):
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

31

The North American Council on Adoptable children states all but which of the following?
a) family of the same racial background are both preferable and better able to prepare children to combat racism
b) long term foster care is preferable to inter racial adoption
c) the ethnic and cultural heritage is an essential right of the child
d) overall supports transracial adoption despite some controversy

b) inter racial adoption is better than long term foster care

32

When do children become aware of race?
a) 2 year old
b) 3 year old
c) 4 year old
d)5 year old

b) at 3 years old
3-7 year old, become aware of different responses with racial groups, what it means to be part of a different race
race permanence age 7

1st on a conceptual level then where they are in a racial group

33

Which of the following statements is true?
a) parents can easily reuse alarms for subsequent children
b) alarms should be brought to sleepover and camp
c) alarms rarely wake up others in the house
d) the cheapest alarms are $500
e) the cure rate for primary nocturnal enuresis using alarm systems is just under 50%

e)true, based on systematic studies
CPS recommends alarms for older children from highly motivated families


a) false, they wear out pretty easily
b) nope, not appropriate
c) loud will wake up everyone
d) not true, lots in 80$ range, warn parents that some very expensive alarms are advertised

34

Which of the following is false?
a) families whose children attend racially integrated schools, live in integrated communities and accept their child's racial identity as black felt more positively about themselves
b)a review of Korean, Vietnamese columbian or white children adopted by Caucasian families suggested that most children adopt OK and any discrepancies usually related to pre adoption experiences
c) all of the current studies in place suggest that children with interracial adoption are far more likely to have self esteem and adjustment issues than their peers
d) delays in placement and poor pre adoptive environment often lead to attachment disorder and other problems
e) girls adopted transculturally are at lower risk of emotional and behavioural problems

c) the evidence is mixed

- 12 year study - adopted children as well integrated as bio children
- another found 75% functioned well
- Canadian survey - self esteem in inter country adoption higher than general population but lower than their peers, 10% thought of themselves as white
- >80% had experienced racism
- Korean study - showed that issues of identity formation a lot more intense in transracial adoptions, girls did a lot better than boys
- Swedish study - interracial adoptions 3-4 x more likely to have mental health problems (suicide, drugs, addiction), but overall most children no signs of trouble with adjustment
- the place to live affected the outcomes with adjustment - worse if living in mostly white communities
- majority are well adjusted, create opportunities for child to learn about their birth culture, give kids tools to deal with racism, recognize that they may face racist remarks, work with similar families
- acknowledges the differences, don't pretend that race doesn't matter

35

Which of the following statements is true?
a) airline passengers are at increased risk of infectious diseases
b) the chance of acquiring a respiratory infection on a plane is high
c) the chance of infection on a plane is higher than on a bus
d) face masks are recommended to decrease the risk of infection
e) airlines can't deny boarding to passengers on a flight

a) true - including TB, influenza, SARS and measles, a few cases of patients with meningococcal disease, no transmission recorded but public health authorities should work with passengers to provide chemoprophylaxis


others - false
b) despite a, the chance is quite low.
c) same as bus or train
) air filters and increased air exchange on planes eliminated most bacteria and viruses
d) not currently recommended
e) they can
f) if a child gets a communicable disease on a plane should be reported to the public health by a doctor

a letter should be provided to parents of children travelling by air including medical conditions, emergency plan, contact information of any personnel

36

Which of the following statements is false? ?
a) behavioural therapies have not been studied using meta-analysis
b) lifting refers to the treatment of waking a child up to void
c) behavioural therapy may contribute to poor self esteem
d) there is strong evidence to recommend behavioural therapy for primary nocturnal enuresis

d) false - limited data about effectiveness of behavioural therapy for nocturnal enuresis, especially adverse effects, so not enough to recommend it.

a) so many differences that hard o study using this method, some small trials that suggest success with rewards system and lifting (but don't look at potential for consequences)

37

Which of the following is the most effective treatment for primary nocturnal enuresis?
a) desmopressin acetate
b) conditioning alarm system
c) imipramine
d) behavioural therapies

b) alarms: most effective therapy - conditioning alarm system, but will be successful in the long term in less than 50% of children. alarms may be most appropriate line of treatment in older children from motivated families.

a) in special situations - i.e. camp, sleepovers, when alarm system is impractical or not effective.
c) imipramine - use very cautiously (only in difficult situations), make sure that parents know about dangers of overdose, most children do not need.
d) rewards system and lifting should not be recommended without careful consideration of and discussion with parents about potential side effects.


only treat if distressing, eliminate guilt, shame and punishment.

38

An infant with chronic lung disease should have all but the following tests done prior to air travel?
a) arterial blood gas
b) O2 saturations
c)chest X ray
d) Spirometry (PFTs)

c) is the answer

patients who should be evaluated for hypoxemia prior to air travel (adult list) below, children should be the same.
- hypoxemia, hypercapnia, COPD/restrictive lung disease, patents on supplemental oxygen, history of previous difficulty with air travel, recent exacerbation with chronic lung disease, other chronic conditions exacerbated by hypoxemia , premature infants
- may need O2

39

The North American Council on Adoptable children states all but which of the following?
a) family of the same racial background are both preferable and better able to prepare children to combat racism
b) long term foster care is preferable to inter racial adoption
c)
d)

lkjk

40

When do children become aware of race?
a) 2 year old
b) 3 year old
c) 4 year old
d)5 year old

b) at 3 years old
3-7 year old, become aware of different responses with racial groups
race permanence age 7

1st on a conceptual level then where they are in a racial group

41

Which of the following statements is false?
a) babies should be encouraged to drink during landing and take off to help them equilibrate pressure in their ears.
b) barotitis media refers to inflammatory change of middle ear secondary to barotrauma
c) children with history of otitis media can be treated with topical nasal decongestant 30 minutes before take off and landing
d) oral pseudoephrine has been shown in studies to decrease ear pain in children

d) false - RT showed no benefit but did increase drowsiness

b) 22% of children have this sudden ear pain, impaired hearing, vertigo and rupture of tympanic membrane, previous ear pain and nasal congestion are risk factors, can be prevented by teaching children to valsalva, tympanostomy tubes, or treating nasal congestion and sinus infection before flight

a) may be more beneficial during descent than takeoff
c) these kids have more trouble regulating the pressure in their middle ear

otitis media with effusion less trouble than AOM

42

Which of the following is true regarding children with otitis media?
a) if treated, safe to fly 2 weeks after diagnosis
b) if treated, safe to fly 48 hour after diagnosis
c) guidelines based on multiple RCTS
d) don't need to be evaluated prior to air travel

a) true

not a lot of studies on this, largely based on expert opinion, if possible should evaluate prior to air travel.

if diagnosis made within 48 hours of a flight that can't be postponed, should provide child with analgesia

43

Which of the following statements is true?
a) airline passengers are at increased risk of infectious diseases
b) the chance of acquiring a respiratory infection on a plane is high
c) the chance of infection on a plane is higher than on a bus
d) face masks are recommended to decrease the risk of infection
e)

a) true - including TB, influenza, SARS and measles, a few cases of patients with meningococcal disease, no transmission recorded but public health authorities should work with passengers to provide chemoprophylaxis


others - false
b) despite a, the chance is quite low.
c) same as bus or train
) air filters and increased air exchange on planes eliminated most bacteria and viruses
d) not currently recommended

a letter should be provided to parents of children travelling by air including medical conditions, emergency plan, contact information of any personnel

44

Which of the following statements is false?
a) there have been a few episodes of food born illness associated with improper handling of food on flights
b) insecticides used on flights from malaria countries are not harmful to children
c) children with CF may be at greater risk from hypoxia during flight
d) even patients with a normal O2 saturation may need further evaluation prior to flying

b) risk to children is unknown, WHO has not found evidence that the insecticides are harmful.

c) hypoxia, may need supplementary oxygen, should get pre flight spirometry.

d)

45

Which of the following interventions is not helpful?
a) capping feeding tubes and catheters during flight
b) melatonin for jet lag
c) using bivalved fiberglass or plaster casts for recent (within 48 hours fractures) and elevating limb
d) securing infants with car seat can help reduce chance of injury, especially with turbulence

b)the answer no evidence that it helps

c) pneumatic casts not allowed on most airlines
d) should not use infant carriers, infants

46

Which of the following is not true of extended release medications (compared to immediate release preparations) for ADHD?
a) difficulty with adherence compared to IR preparations
b) reduced stigma
c) reduced problems for school to administer drugs
d) better pharmacokinetics
e) less visits to ER departments
f) similar efficacy as IR

a) in fact better adherence
- 1/2 of children prescribed immediate release medications refuse to take it
- older children most likely to stop (stigma of school to administer drugs)
- some SEs too
studies show better adherence and use of drug for much longer with XR preparations

efficacy - how drug works in study conditions
effectiveness - how study works in real life

e) better for injuries - is it because better because of adherence or because longer therapeutic effects
f) similar efficacy but better effectiveness

extended release preparations are often more expensive, for poorer families that are disproportionately affected by ADHD

47

Which of the following is false?
a) children with ADHD at increased risk for substance abuse
b) children with ADHD who are unmedicated are at increased risk of substance abuse compared to those who are medicated
c) immediate release preparations of stimulant medications have been found to be diverted and used for partying more than XR forms
d) both IR and XR forms are equally likely to produce euphoria

d)XR harder to extract and less likely to produce euphoria

**recent systematic review - IR stimulants more likely to be rivered and misused

1st line should be extended release preparations, we should work to make them more available for people

48

Which of the following statements is false?
a) sickle cell patients have documented any medical problems during routine air travel
b) sickle cell patients should have medical O2 available on planes
c) O2 therapy for sickle cell is the most important > 7600 ft

a) false, no documented cases but because of hypoxia do have increased risk of crisis

the others are two
c) especially if splenomegaly or high blood viscosity.

49

Which of the following statements is false?
a) babies should be encouraged to drink during landing and take off to help them equilibrate pressure in their ears.
b) barotitis media refers to inflammatory change of middle ear secondary to barotrauma
c) children with history of otitis media can be treated with topical nasal decongestant 30 minutes before take off and landing
d) oral pseudoephrine has been shown in studies to decrease ear pain in children

d) false - RT showed no benefit but did increase drowsiness (remember can use the nasal one, NOT oral one won't help)

b) 22% of children have this sudden ear pain, impaired hearing, vertigo and rupture of tympanic membrane, previous ear pain and nasal congestion are risk factors, can be prevented by teaching children to valsalva, tympanostomy tubes, or treating nasal congestion and sinus infection before flight
symptoms of barotitis media: inflammatory changes in the ear from barotrauma
ear pain, decreased hearing, vertigo/TM rupture

a) may be more beneficial during descent than takeoff
c) these kids have more trouble regulating the pressure in their middle ear

50

Which of the following is true regarding children with otitis media?
a) if treated, safe to fly 2 weeks after diagnosis
b) if treated, safe to fly 48 hour after diagnosis
c) guidelines based on multiple RCTS
d) don't need to be evaluated prior to air travel

a) true

not a lot of studies on this, largely based on expert opinion, if possible should evaluate prior to air travel.
if it is 48 hours then give them analgesia

51

Which of the following is true about children and peanut allergies?
a) peanut free zones are very effective
b) parents should carry an epipen and antihistamines
c)children are only exposed to nuts through direct contact
d) there is no benefit to informing the airline of a child's allergy

b)

peanut dust can get distributed through the ventilation system of the plane, passengers can bring peanuts, mean age 5.9 years

52

Which of the following is not a good idea?
a) avoiding chloral hydrate (excessively) for children with ADHD on plane trips.
b) prepare child for air travel with books and by telling them what is going on
c) avoiding the rear of the cabin if get air sick
d) using gravol for sedation

d)not a good idea, sedation plus lower O2 can be risky for some

a) can cause oversedadation or paradoxical irritability

diabetes, seizures, bring your meds. diabetes may need to adjust dose if time change, seizures tell the flight, may lower threshold, bring meds.

53

Which of the following interventions is not helpful?
a) capping feeding tubes and catheters during flight
b) melatonin for jet lag
c) using bivalved fiberglass or plaster casts for recent (within 48 hours fractures) and elevating limb
d) securing infants with car seat can help reduce chance of injury, especially with turbulence

b)the answer no evidence that it helps

c) pneumatic casts not allowed on most airlines

54

Which of the following is not true of extended release medications for ADHD?
a) difficulty with adherence
b) reduced stigma
c) reduced problems for school to administer drugs
d) better pharmacokinetics

a) in fact better adherence

55

Which of the following is false?
a) children with ADHD at increased risk for substance abuse
b) children with ADHD who are unmedicated are at increased risk of substance abuse compared to those who are medicated
c) immediate release preparations of stimulant medications have been found to be diverted and used for partying more than XR forms
d) both IR and XR forms are equally likely to produce euphoria

d)XR harder to extract and less likely to produce euphoria

**recent systematic review - IR stimulants more likely to be rivered and misused

56

name 3 absolute contraindications to air travel (medical conditions)

uncontrolled pulmonary hypertension
Eisenmenger syndrome
uncontrolled SVT