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Which of the following is false?

a) formal training contributes to quality child care
b) high quality childcare may have positive effects on both behavioural and cognitive domains
c) for profit daycare centres had better scores than non profit centres in one study
d) only 16% of Canadians have access to regulated child care


c)false, the opposite, non profit was betteroverall quality was 60%, non profit was 62% vs 55% for for profit , need 67% to promote child development

for children at lowest income level, amount of non parental care directly proportional to household income
having at least an associate degree in early childhood education is recommended in the USA - in Canada 30% have ECE in homes, 36% in childcare centres
evidence is hard to study - methods issues, etc. lots of conflicting evidence’ good quality childcare can have benefits
d) true only 16% have access to regulated chip care, 50% in Quebec, Quebec 5$ per day, Manitoba also set a price
other Canadian provinces no
better language outcomes when good quality childcare compared to family member


What is the recommended caregiver to adult ratio for a 29 month old child?

a) 3:1
b) 4:1
c) 5:1
d) 7:1


b) 4:1

AAP and American Publich Heath recommends:
for <24 months 3:1
for 24-30 month: 4:1 
for 30-36 month: 5:1 
for 36 months: 7:1 or less

the promotes more interaction for the child

very few onsite child care facilities in Canada, should consider getting more


Which of the following statements is false?

a) children in daycare have more foreign body aspirations that those cared for at home
b) children who spend more time in non parental child care have a reduced risk of unintentional injury
c) very few injuries are a result of purely environmental factors
d) most daycare injuries occur in boys on playground equipment, most injuries occur 1 hour before lunch


a) false - based on a Canadian study, more cuts/abrasions in the daycare group, but statistically fewer burns, poisonings and foreign body insertions compared with the nondaycare (control) group. most injuries were play yard injuries/collisions with other child etc.

b) true - might be because family day homes and daycare centres provide better supervision or safer equipment to play on
c) true - San Fran study - 56% child factors 42.9 % child and environment, 1.5% environment alone - supervision is critical


Which of the following is not a recommended intervention to make child care centres safer?

a) all personnel should be trained in PALS
b) play equipment should meet the current Canadian standards association
c) an injury reporting procedure and form should be available in all childcare centres
d) checklists may help make daycare centres more safe


a) false - should be trained in basic first aid and CPR


Which of the following age groups of children had the greatest respiratory illness sick days?

a) children in daycare age 3 months
b) child in daycare > 1 year old
c) children not in daycare age >3 months


b) children in daycare who are 1 or older
for the kids younger than 3 months - no huge effect, perhaps protection from maternal antibodies
thought to have protective effective of maternal antibodies or because this age group can’t move around and pick up germs as easily

daycare children every 9h in daycare 12% increase in respiratory sick days 3 fold increase in children without siblings
after 6 months in daycare, fewer otitis, URTI, conjunctivitis (compared to children fewer than 6 months in daycare)


Which of the following infections is known to be transmitted in childcare settings?

a) HIV
b) hepatitis B
c) hepatitis C
d) Helicobacter pylori


d) Helicobacter pylori, CMV and skin infections are transmitted

GI illnesses : rotavirus, vaccine helps, handwashing/purrell
vaccine preventable illness - pertussis (consider getting daycare workers updated for this), immunize children as per he schedule, annual influenza, ensure that tetanus and diphtheria are current

hep B small chance of infection with skin broken
HIV unlikely hep C unlikely


Which of the following children should be excluded from daycare?

a) 8month old with mild RSV who is feeling well
b) 3 year old with bloody diarrhea
c) 2 year old with bacterial conjunctivitis who started antibiotics 2 days ago
d) 5 year old with strep pharyngitis who started antibiotics 4 days ago


b) bloody diarrhea should not attend
for diarrhea - should exclude if can’t contain by diaper, can’t control by toilet trained child or signs of bacterial enteritis (fever, blood, mucus in stool)
child care centre should talk to public health- different policies for exclusion for shigella, ecoli, campylobacter, salmonella and giardia)

respiratory conditions can attend as well as well enough to participate (there is another part in the statement that talks about daycares making exclusions for children no being able to attend with URTI if they are on antibiotics, and how this might be related to increased antibiotic use)
for strep pharyngitis or bacterial conjunctivitis, after 24 hours of antibiotics can attend daycare


Which of the following is true?

a) currently, Canadian daycares are not obligated to have a policy on the management of a sick child
b) there are many sick child care centres in Canada
c) employers should not consider providing penalty free time off for parents to care for their sick children who are excluded from child care


a) true - currently not obligated to have a policy on the management of a sick child, but helpful for daycare providers to know about common conditions and serious infections

b) false - unknown exactly how many but doesn’t seem like much
c) false, they should do this, one study showed that working moms needed 5.6-28.8 days off of work each year to take care of their sick children


Which of the following has not been linked to poor oral health?

a) poor growth
b) excess iron
c) poor sleep
d) poor learning
e) low birth weight


b) in fact iron deficiency has been linked

the others have all been linked
as well associated with trouble with development, self-esteem, communication, worse attendance at school and parental absence at work


Which of the following is the most common chronic childhood disease in children age 5-17?

a) ulcerative colitis
c) tooth decay
d) asthma


c) tooth decay - reported to be the most common by the CDC report, 5x more common in children aged 5-17

57% of Canadian school aged kids have had a cavity, on average 2.5 teeth are affected by each


What is the definition of early childhood caries?


one or more decayed, missing (due to cavities) or filled primary tooth in a preschool aged child


What is the prevalence of early childhood caries in some indigenous communities in Canada? As high as:

a) 5%
b) 25%
c) 75%
d) 90%


d) as high as 90% in some indigenous communities, in comparison, in advantaged Canadian communities, as low as 6-8%


What is the most common surgery performed in most Canadian children’s hospitals?

a) appendectomy
b) bronchoscopy
c) tonsiloadenoidectomy
d) extraction of teeth under anaesthesia


d) extraction of teeth under general anaesthesia for cavities, most common surgery in most Canadian hospitals

dental health - was not included in the final Romanow Commission report on the Future of Health Care in Canada in 2002; since then, there have been some steps to draw more attention to the subject
very bad wait times got a D - only 50-59% in appropriate wait time, very expensive costs to the heath care system, often after extraction get another cavity soon after (especially first nations)


True or false : dental care is covered under the Canada Health Act


false - historically not considered essential to care, and therefore not covered (ppl pay for most of their own dental care)


Name the tenets of the Canada Heath Act


publicly administered, universal, portable, accessible and comprehensive
Canadians pay for dental care in four different ways: through third-party insurance (employment-related dental coverage); through private dental insurance; by paying directly out-of-pocket; or through government-subsidized programs (eg, First Nations Non-insured Health Benefits [NIHB] or Veterans’ Affairs).


How many Canadians have no dental insurance?


62% have private insurance, 6% have public insurance (so not that many!)
public programs don’t reimburse nearly as much as private ones, can lead to discrimination from dentists who won’t accept them (based on one study)
the working poor are the most marginalized by this system
50% of Canadians in the lower income bracket don’t have insurance


Which province has the lowest publicly funded dental care?

a) Ontario
b) Alberta
c) Yukon
d) Nunavut


a) Ontario - lowest publicly covered dental health 1.5%
in Nunavut the highest 77%

The Canadian government’s per capita public expenditure on dental treatment has increased from $11.00 in 1975 to just $19.54 in 2010, whereas private sector spending has almost tripled over the same period (from $135 to $379 per capita).[


Name 3 factors important to counsel patients to reduce dental caries

  1. reduce bottle propping
  2. reduce juice consumption
  3. improve diet
  4. water fluoridation
  5. use fluoridated toothpaste, counsel people to brush teeth

How many communities in Canada have fluoridated water?


only 45.1 %, in Ontario higher (76%) vs 1.5% in newfoundland and labrador
the canadian dental association endorses water fluoridation and topical fluoride use


Name one group that should receive regular topical fluoride?


First Nations and other high risk groups (
recent cochrane review
separate statement on this, need to review it


Which organism is most commonly associated with early childhood caries?


Streptococcus mutans
transmitted from caregiver to infant
can also be transmitted horizontally in child care setting
window for infectivity 19-31 months of age
early intervention for the caregiver and counselling are important strategies to decrease transmission to the child
early childhood caries - most likely to have cavities later


True or false - universal access to dental care will eliminate disparities in dental care


false - one study suggests that this won’t happen, there are more complicated factors that influence dental care

other things that can affect - distance/lack of dentists (i.e. First Natons) medically complex children (in this case, some dentists not trained, can also lead to delaying of procedures


True or false - all provinces offer some support for dental care for children on income assistance


true - for these kids, all provinces provide some help
in general dental health is a provincial responsibility
low income families usually get some provisions (look at the list for details0
often further targeted provisions in legislation concerning children with disabilities or children in foster care
overal treatment based rather than preventative based


Ideally, when should children have their first dental visit?


within 6 months after their first tooth appears, no later than 1 year old (Canadian Dental Association), AAP says the same thing
Rourke baby record 9-15 months for the first visit
but most people don’t follow this, limited uptake
most physicians don’t get any training in oral health
need surveillance and research


True or false Long term studies of lacto-ovo-vegetarians suggest that they can get enough energy intake from their diet


true there have been studies of these veggies (who each milk and eggs) and we know they can get enough energy to grow, insufficient evidence for vegans

2% of 6-17 year olds in US say vegetarian, 0.5% vegan


True or false - protein intake needs to be increased for children who are on vegetarian diets


this is true, because the proteins from plant sources have lower digestibility (so need more of them
increase by 30-35% for 6 year old
Therefore, recommended protein intakes are adjusted upward for children in the range of 10% to 15% compared with nonvegetarians
soy protein - can be as effective as animal protein
wheat protein - may be 50% as good as animal protein


Name the major plant sources of protein


legumes (beans and lentils), cereals, nuts and seeds, butters; Combining complementary proteins in each meal, however, is not believed to be necessary for children who eat often throughout the day


True or false - vegetarian children need more iron than meat eating children to avoid getting iron deficient


true- may need up to 1.8 x more iron because of different bioavailability
certain things like vitamin C (and other components in vegetables) enhance the absorption of non heme iron)
Other substances such as dietary fibre, phytates and tannins may inhibit absorption, and, therefore, a balance must be achieved
good iron sources - include iron fortified cereals, grain products, dried peas and beans, or supplementation
may need supplementation during periods of rapid growth
overal studies do suggest that they can maintain their iron levels if they follow good practices above


All of the following improve the bioavailability of zinc except the following?

a) phytates
b) sprouting seeds and grains
c) fermenting
d) none of the above (all improve the bioavailability)


a) phytates which are found in high quantities in vegetarian diets decrease the bioavailability of zinc

the others are ways to increase the bioavailabiily of zinc
breastfeeding gives sources of zinc until about 7 months
zinc deficiency is rare
vegans may need 60% more than omnivores
most zinc comes from animal protein
additional supplementation not recommended, but should eat high zinc foods (i.e. legumes, nuts, yeast-leavened breads, fermented soy products, etc)


True or false - calcium content in breastmilk is lower in the milk of a vegan mother


false - calcium content is unaffected by the intake of a vegan mother
overal, calcium deficiency is rare in lacto-ovo vegetarians (since they likely eat lots of dairy), however, do need to think about it in vegans (have shown that they can have lower than recommended calcium)
after weaning, ensure enough calcium intake fortified soy products, cereals, juices and leafy vegetables. Low-oxalate greens (bok choy, Chinese cabbage, kale, collards, etc) provide highly bioavailable calcium for the older child. may need supplementation


How should vegan children compensate for the lack of long chain omega 3 acids in their diet?


eat more precursor linolenic acid (found in flaxseed and canola oils, walnut and soy products), this will get converted to long chain omega 3 fatty acids (DHA and EHA)
omega 3 fatty acids should provide 1% of the caloric intake of vegetarians


A vegan mother is exclusively breastfeeding her 5 month old. What are 2 supplements the baby should get?


vitamin B12- vegans at high risk, breastfeeding mothers who are vegan also low in B12, should supplement
**the B12 deficient anemia may be masked because of high folic acid intake in most of these children, however, the neurological symptoms can still happen”
for older kids : It is recommended that at least three servings of food rich in vitamin B12 be included in the daily diet or supplementation be provided at 5 µg to 10 µg per day
vegetarians should get enough B12 from eggs
vitamin D : all kids should get it, vegan at more risk because we get some vitamin D from iver, fatty ocean fish and egg yolks,
inn addition, Canadian children younger than two years of age living above a northern latitude of 55°, those with dark skin and those avoiding sunlight should be supplemented with 800 U of vitamin D in the winter months from October to April; for kids >1 year old, should get 200 units (check the other new statement to see if this has changed)


True or false - riboflavin deficiency is common in vegetarian children


false - clinical deficiency not observed


True or false - preformed vitamin A is only found in meet


true - therefore, they need to convert dietary carotenoids – found in yellow and orange vegetables, leafy green vegetables and fruits rich in beta-carotene – into vitamin A. Three servings a day of such vegetable and fruit products is adequate


How much fiber should a child consumer ?


0.5 g/kg/day

some vegetarian kids, 3x that, may lead to poor nutrient absorption and growth


A breastfeeding mother comes to you for advice about what she should eat to ensure her baby gets enough nutrients. She is vegan. what do you tell her.

  1. B12 - ensure you eat enough fortified foods to give that
  2. calcium - your milk will still have good calcium levels, however you should take a supplement to make sure yo don’t get depleted
  3. vitamin D - in the winter months, all pregnant and lactating mothers should take 2000 units/day
  4. may have lower omega 3 levels, so ensure that you take lots of the precursor foods (i.e. flaxeed, cprecursor linolenic acid (found in flaxseed and canola oils, walnut and soy products), this will get converted to long chain omega 3 fatty acids (DHA and EHA) unsure of the significant of lower levels of this in the cord bloods of vegan mothers, but given that we think it’s important for eye and brain development should take it
    Also, intake of foods containing inhibitors of DHA production (linoleic acid and trans fatty acids [shortening and stick margarines]) should be limited
  5. zinc supply in bm should be okay till 7 months

true or false - vegetarian diets in adolescence may mask eating disorders


true - vegetarian diets may mask eating disorders - although not causally associated
in teens make sure they are getting enough B12, calcium, vitamin D and iron

athletes - protein may need to be increased (1.2-1.4 g/kg and 1.6-1.7 g/kg); energy, calcium and iron monitor
vegetarian athletes are okay


What is a macrobiotic diet?


Macrobiotic diets: Not necessarily vegetarian, but based largely on grains, legumes and vegetables. Many also include some animal products.
Others: Rastafarian and fruitarian – extremely restrictive vegan diets.
likely need a dietician to help with these


How many Canadians don’t have ht illiteracy level needed to function in today’s economy?


42% of adults aged 16-65 don’t have minimum literacy skills for coping with everyday life and work in a knowledge-based economy and society (the skill level typically required for high school completion in Canada); 15% within this group struggle with any written material
even higher among other groups: 80% of prison inmates, 60% of immigrants, 18-38% of youth aged 16-25 years
aboriginals - 17% have less than grade 9 education; decreases with age 80% of seniors inadequate literacy skills
5% to 15% of schoolchildren have reading delays [10]. Most children who have not mastered reading by the end of grade 3 will never catch up
low literacy ->low income, low education, low employment


Name 4 direct effects of low literacy on patient health

  1. bad at taking meds
  2. mistakes preparing formula
  3. don’t understand/comply with medical directions
  4. safety risks in community, workplace, home

Name 4 indirect associations of low literacy and patient health

  1. more poverty
  2. more occupational injuries
  3. more stress
  4. unhealthy lifestyle practices (smoking, nutrition, helmets/seatbelt, less breastfeeding, less bp check/paps etc) limited ability to understand heath info, inappropriate use of medical services

True or false - higher SES kids say more than 2x as many words as poor families by the age of 3


early years, make synapses between neurone don’t use it you lose it.
both amount and quality of language exposure are crucial to help with language development


Which of the following was not a finding of the reach out and read program in the USA?

a) parents want info from their physician about learning
b) parents in the ROR program were 4-10 x more likely to read to their children, particularly evident effect in poorer children
c) the distribution of books is equal to anticipatory guidance by a paediatrician
d) the children with intervention had higher receptive and expressive language scores on tests


c) false - Parents often place more importance on reading to their children when a book is given by a paediatrician [19]. (Level III). The distribution of books enhances the effectiveness of literacy intervention beyond what is achieved by anticipatory guidance alone [

its three components are anticipatory guidance regarding literacy development by paediatric providers at each well-child visit; the provision of a new, developmentally appropriate book at each visit; and literacyrich waiting rooms including volunteers who demonstrate book

Preschoolers receiving the intervention have higher receptive [23][26][27][28] and expressive [26][27] language scores on standardized tests. (Level II-1)
There is a dose-response relationship between exposure to a literacy promotion intervention and desired literacy-related behaviours [29]. (Level II-2)
Parents rate physicians who demonstrate reading aloud and give books as more ‘helpful’ [25]
not perfect studies - not RCT, also population was mainly spanish speaking poor kids


A child is able to hold a book with help, turn pages multiple at a time, points at a picture with one finger and when the father won’t give her the book, gets upset. How old are they


12-18 months: does the things listed, may label a picture with a sound, may refuse if parents insist they read; may bring book

different ages (see chart for all details) 6-12 months - tries to eat the book, reaches for the book, looks at the pictures, prefers photos of faces, can hold the child comfortably face to face

18-36 months : may carry the book around the house, names pictures, wants the same story over and over, reads to dolls, fluctuating attention span
3 and older - can retell a familiar story
incorporate books into the visit
talks about different books for different ages


True or false - chiropractry has been around since ancient greece


false - spinal manipulation has been around for a long time, but chiropractry only since 1895
central tenet; diseases are often caused by subluxations of the vertebrae, which, in turn, lead to an interruption of nervous impulses; and that the correction of these subluxations allows the body to heal itself. This is still a central tenet of chiropractic.
chiropractic is the most established discipline considered to be alternative by practitioners of conventional medicine. their largest grip of HCPs (after doctors and dentists) to have contact with patients


True or false - a MSK problem must be diagnosed before chiropractry is provided


true - practioners believe that need to ID a MSK problem before treating, however still debate as to whether they are a nonsurgical medical discipline or whether they are an alternative care method (BUT lots of debate, only the most conservative chiropractors believe this, 19% in one survey) now lots more believe that they can treat anyone
5000 chiropractors in Canada


Which is the most common treatment provided by chiropractors?

a) exercises
b) spinal manipulation
c) soft tissue treatment
d) postural and nutritional counselling


b) spinal manipulation most common, next are exercises, soft tissue treatment and postural and nutritional counselling
lots of chiropractors treat non MSK illnesses in kids, as well as advise on prevention
in children, chiropractic is also commonly used as primary or adjunctive therapy for nonmusculoskeletal conditions such as colic, enuresis, asthma, recurrent otitis media, cancer and illness prevention


Which of the following is false?

a) some studies show that spinal manipulation may help in lower back pain in adults, other studies show that they don’t help
b) numerous paediatric studies on the use of chiropractor for back pain support their use
c) chiropractic treatments does not help asthma based on a study
d) chiropractic treatments such as cervical manipulation does not help migraines
e) cervical manipulation does not help neck pain based on limited evidence


b) false - no studies on paediatric back pain and chiropractor

the other statements are true
the only decent study showed it doesn’t help in asthma
the other studies are crap and need better methods
some chiropractors say that RCTs aren’t the way to go for evidence, unhung…
colic- 2 studies, 1st one not blinded second one showed no difference vs. placebo


True or false - the Canadian chiropractic association supports vaccination


true - CCA is okay with vaccines, (although all may no agree) American CA emphasizes the risks of vaccines. american chiropractors - 1/3 are against vaccines


What is the main risk of chiropractic treatment in children?

a) delay in conventional treatment and potential for worsening of acute conditions
b) vertebrobasilar ischemia


a) greater concern is chiropractors will try to treat acute conditions leading to the delay in treatment or refusal to get conventional treatment
with regards to risk of stroke
- if kid has headache or signs of stroke, should ask about neck manipulation in the past week; in adults, reports of vertebrobasilar accidents after neck manipulation, one report in a child; however overall the risk remains low
in adults, common to get mild pain, fatigue, slight headache (transient) after manipulation. one canadian study risk of stroke after chiropractor 1/5.85 million adults
(likely conservative)


A parent tells you that they are seeing a chiropractor for their child. What are two things you should ask as follow up.

  1. are they using neck manipulation/forceful thrusts
  2. are they getting any herbal/homeopathic remedies
    if a chiropractor has convinced them not to get vaccinated, then point out that the CCA supports vaccination **

A parent wants an X ray of their child’ neck because their chiropractor has told them that subluxation of the vertebrae is a likely cause of their child’s otitis media. What do you do?


controversial issue - alberta radiologists have banned chiropractic X rays
tell the parents that the scientific basis for this is contentious, and that the X ray exposes their child to unnecessary radiation
**in Ontario, there are now special facilities where chiropractors can order X rays, the chiropractor must read the x ray (which is uninsured) the radiologist reading of the x ray is not an insured service. not covered under quality control act (the ministry pays for the technical part of the X ray)


Which health record should be used for preventative visits for the 6-17 year old child?

a) Rourke heath record
b) Grieg heath record
c) none of the above


b) Grieg for 6-17 year olds, Rourke is for babies
no tool before but lots of guidelines existed, the Grieg incorporates these

three age ranges: six to nine years, 10 to 13 years and 14 to 17 years inclusive. Headings for sections include weight, height and body mass index; psychosocial history and development; nutrition; education and advice; specific concerns; examination; and assessment, immunization and medications ; also has section for Fhx, RFs


Which of the following is not part of the physical examination SCREENING on the Greig health record as developed by consensus?

a) height and weight
b) blood pressure
c) screening maneuvers for scoliosis
d) visual acuity screening


c) CR not included in the consensus agreement
they agree on height/weight, BP, visual acuity screening
other exams should be done at the discretion of the clinician

there is evidence to support the EXCLUSION of screening maneuvers for scoliosis, as well as to exclude counselling for breast and testicular self-examination

physical examination in which height, weight, body mass index (BMI) and blood pressure are measured, and the stage of sexual maturity assessed in the adolescent.


How often should children aged 6-17 years have preventative visits with their doctor?


every 1-2 years (no compelling evidence, consensus)
america says every year
in younger children, evidence suggests that reducing the interval of visits doesn’t increase negative outcomes


What are the exceptions to confidentiality?


homicidal or suicidal ideation
emotional, physical, sexual abuse
should always do part of the visit in confidence
limits to confidentiality
mature minors can make decisions in most provinces
(remember that in Quebec need to be 14 to make decisions - double check, this is in a different statement)


Which of the following is best supported by evidence?

a) promotion of physical activity
b) avoidance of firearms in the home
c) regular dental care
d) home smoke detectors
e) safe sun advice


c) regular dental care - under the good evidence list
good evidence for: bicycle helmets, seatbelts and booster seats, regular dental care and avoidance of second-hand smoke, immunizations
fair evidence for: screening for major depressive disorder in adolescents, promotion of physical activity, avoidance of firearms in the home, safe sun practices and use of home smoke detectors, blood pressure screening
evidence AGAINST: breast/testicular self exam (breast: no benefit, may harm, low prevalence of breast cancer)(testicular : low incidence in average risk individuals) , scoliosis screening maneuver

varying/conflicting evidence for different things
also, the evidence refers to the evidence that using the thing (i.e. helmet) reduces the negative outcome, NOT whether counselling actually changes the use (i.e. counselling and increasing helmet use)


True or false - growth and immunization must be included in the Greig heath record


false - not included since they are in the baby record

overall use discretion, meant to be used as a guide


Which growth charts should be used in children?

a) WHO
b) CDC
c) neither


a) WHO growth charts reflect child growth under optimal conditions for children <5, and for older kids, aligned with the growth of these kids (separate growth chart on this) the Grieg health record says also to use these, which suggest BMI after age 10


What is the BMI cut off for overweight in adults?

a) >20 kg/m2
b) >23 kg/m2
c) >25 kg/m2
d) >30 kg/m2


c)in adults >25 kg/m2 is for overweight, >30 kg/m2 for obese, the WHO growth chart


What percentile is the BMI cut off for obese children >10 year old?

a) >60th percentile
b) 60-85th percentile
c) 85th-97th percentile
d) >97th percentile


d) obese >97th percentile

overweight is 85-97th percentile

Which of the following should be screened for in children 
a) major depression
b) precocious puberty
c) STIs

b) puberty - should assess for puberty changes on physical exam
a) no evidence for screening for major depression in children, fair evidence for screening in adolescents
c) in sexually active adolescents only


What age is precocious puberty in girls?


before age 7-8 (some say should be even younger in some cultures)
in boys it is before 9 year old


True or false - the risk of cervical cancer in adolescents is low


true - new recommendation don’t need pap till age 21 and then 3 years after that
risk of cervical cancer in adolescents is low, most dysplasia will resolve spontaneously (before used to say within 3 years of onset of vaginal sexual activity)


Which of the following should be screened for in all female teenagers?

a) chlamydia
b) gonorrhea
c) HIV
d) syphillis


a) chlamydia - grade A evidence to recommend for screening of females, yearly (based on american guidelines but some discussion about interval), insufficient evidence to recommend screening for males
gonorrhea - for high prevalence of gonorrhoea
chlamydia and gonorrhea - highest risk in <25 year olds

HIV/syphillis - for high risk
should also discuss menstruation, dysmenorrhea, assess for risk of iron deficiency


How many healthy Canadian children use CAMs


20-40% in heathy, 50% in chronic ill, >70% in street youth/vulnerable youth


True or false - counselling with written material can increase physical activity


true - it can increase (modestly) physical activity


True or false - certain television programs can encourage sexually irresponsible behaviour


true - certain programs can encourage sexually irresponsible behaviour


What is the upper limit of recommended noise level for occupational use?

a) 60 dB
b) 85dB
c) 100 dB
d) 120 dB


b) 85 dB - upper limit for occupational use
100-120 dB at concerts level
many teens can have hearing loss from excessive noise with leisure activities


How much sleep do teenagers need at night?

a) minimum 6 hours
b) minimum 7 hours
c) minimum 8 hours
d) minimum 9 hours


d) 9-9.5 hours (although most people less)


True or false - physician counselling results in some increase in seatbelt use


true based on a systematic review


Which of the following is more effective in crash prevention?

a) driver education
b) graduated license programs


b) graduated license programs are more effective (in contrast to driver education programs) reduce the crash risk by 20-40%


What is the CPS recommendation about the minimum age for operation of ATVs and snowmobiles?


minimum age of 16 year old , more risk of injury in children under this age
should not have children as passengers either


true or false - firearms in the home increase the risk of unintentional injury


true - they do (fair evidence)


true or false - children under the age of 10 should not be on a trampoline


false - CPS recommendation is eliminate trampoline from home environment
Health Canada says minimum age for trampoline use is 6 and all kinds of rules


true or false - swimming lessons prevent drowning


false - insufficient evidence that swimming lessons and water safety education prevent injury , swimming lessons do improve swimming ability and water recovery
swimming learned most efficiently at age 5
swimming for physical activity


Which are the two most important strategies to prevent drowning?

  1. active supervision

2. pool fencing


What amount of working is concerning in terms of its potential for distress for teens?


> 20 hours
also family businesses and fishing are at risk for younger workers
most occupational injury and illness are preventable, should warn the teens of dangers


true or false - there is evidence that smoke detectors save lives


true - there is fair evidence of this, should encourage families to have functioning smoke detectors


true or false - reporting of child maltreatment is mandatory in all canadian provinces and territories


true - in the statement it says except in Yukon, but since 2010, yukon also makes it mandatory to report


true or false - specific screening for abuse should be done at routine visits


false - evidence recommends not to do specific screening, but should always keep a heads up for abuse**


True or false - there is strong evidence for counselling against alcohol and smoking in teens at routine visits


false - conflicting evidence on whether counselling makes a difference
also, don’t do drugs screens on teenagers
smoking as a teenager is a predictor for smoking into adulthood


Which of the following should not be done routinely during heath supervision visits as per the Canadian guidelines?

a) yearly blood pressure measurements
b) visual acuity measurements at every routing heath supervision visit
c) yearly screening exam for scoliosis
d) adolescents should have SMR ratings done at some point during health supervision visits


c) don’t do the scoliosis screening
shows that mild scoliosis resolves with no major harms,
more potential harms from bracing
should evaluate scoliosis when it presents as symptom or found incidentally
(however the orthopaedic association and AAP still stay to screen, although not much evidence)


Which of the following is the most sensitive and specific test for iron deficiency?

a) ferritin
b) Hg
c) none of the above


a) ferriting is more sensitive and specific test for iron deficiency
should have a high suspicion for iron deficiency in menstruating girls
remember it is an acute phase reactant, may be elevated with inflammation


Who should be considered for screening for iron deficiency in adolescence, name 2 groups

  1. dietary restrictions - ie vegan
  2. ethnic or other risk factors
  3. high suspicion in menstruating girls

Which blood work is recommended for all teenage girls as part of their heath supervision?

a) Hemoglobin and ferritin
b) rubella titre
c) screening for sickle cell
d) lipid and plasma glucose screening


b) rubella titer is recommenended, otherwise evidence does not support routine lab investigations

sickle - cell- part of newborn screen, not enough evidence to screen older kids and teens

lipid and plasma glucose - for overweight and obese children > 10 years old (evidence for routine screening is lacking according to this statement)


A 14 year old who was previously unvaccinated is worried about chicken pox and wants to know if he is protected from it. What are your two options for management?

  1. give the vaccine for varicella (two doses 4-6 weeks apart)
  2. do the serology - 80% will be immune despite a negative history

How many children >13 years old will be immune to varicella despite a negative history?

a) 40%
b) 60%
c) 80%
d) 90%


c) 80% will be immune despite a negative history, therefore do the serologies or give the vaccine in these kids


Who should be screened for TB in Canada?


high risk groups (i.e. immigrants from high TB areas)



True or false: healthy children only require one does of meningococcal vaccine


false - all children should get a second vaccine (ACYW135) in adolescence even if they are vaccinated earlier
from the CPS on meningococcal vaccine, all kids should get
1. MCV-C (aka Menjugate) at 12 months of life, and MCV4 or MCV-C booster at 12 years old

kids with increased risk (i.e. antibody deficiency) - should get the quadrivalant vaccine (ACYW135) at age 2


True or false - girls who are aged 14-26 but already sexually active do not need the HPV vaccine


false - may not have been exposed to all strains even if sexually active, not a substitute for cervical cancer screening

NACI recommends for all girls 9-13, and for unvaccinated girls age 14-26 (if not already vaccinated)