CPS statement volume 4

Question 1

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

Answer 1

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

Question 2

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

Answer 2

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

Question 3

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

Answer 3

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

Question 4

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

Answer 4

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

Question 5

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

Answer 5

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)

Question 6

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

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

Answer 6

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

Question 7

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

Answer 7

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

Question 8

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

Answer 8

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

Question 9

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

Answer 9

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

Question 10

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

a) ulcerative colitis
b) ADHD
c) tooth decay
d) asthma

Answer 10

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

Question 11

What is the definition of early childhood caries?

Answer 11

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

Question 12

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%

Answer 12

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

Question 13

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

Answer 13

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)

Question 14

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

Answer 14

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

Question 15

Name the tenets of the Canada Heath Act

Answer 15

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).

Question 16

How many Canadians have no dental insurance?

Answer 16

32%
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

Question 17

Which province has the lowest publicly funded dental care?

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

Answer 17

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).[

Question 18

Name 3 factors important to counsel patients to reduce dental caries

Answer 18

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

Question 19

How many communities in Canada have fluoridated water?

Answer 19

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

Question 20

Name one group that should receive regular topical fluoride?

Answer 20

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

Question 21

Which organism is most commonly associated with early childhood caries?

Answer 21

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

Question 22

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

Answer 22

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

Question 23

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

Answer 23

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

Question 24

Ideally, when should children have their first dental visit?

Answer 24

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

Question 25

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

Answer 25

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

Question 26

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

Answer 26

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

Question 27

Name the major plant sources of protein

Answer 27

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

Question 28

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

Answer 28

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

Question 29

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)

Answer 29

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)

Question 30

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

Answer 30

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

Question 31

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

Answer 31

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

Question 32

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

Answer 32

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)

Question 33

True or false - riboflavin deficiency is common in vegetarian children

Answer 33

false - clinical deficiency not observed

Question 34

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

Answer 34

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

Question 35

How much fiber should a child consumer ?

Answer 35

0.5 g/kg/day | some vegetarian kids, 3x that, may lead to poor nutrient absorption and growth

Question 36

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.

Answer 36

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

Question 37

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

Answer 37

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

Question 38

What is a macrobiotic diet?

Answer 38

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

Question 39

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

Answer 39

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

Question 40

Name 4 direct effects of low literacy on patient health

Answer 40

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

Question 41

Name 4 indirect associations of low literacy and patient health

Answer 41

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

Question 42

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

Answer 42

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

Question 43

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

Answer 43

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 sharing 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

Question 44

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

Answer 44

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

Question 45

True or false - chiropractry has been around since ancient greece

Answer 45

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

Question 46

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

Answer 46

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

Question 47

Which is the most common treatment provided by chiropractors? a) exercises b) spinal manipulation c) soft tissue treatment d) postural and nutritional counselling

Answer 47

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

Question 48

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

Answer 48

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

Question 49

True or false - the Canadian chiropractic association supports vaccination

Answer 49

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

Question 50

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

Answer 50

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)

Question 51

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

Answer 51

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 **

Question 52

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?

Answer 52

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)

Question 53

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

Answer 53

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

Question 54

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

Answer 54

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.

Question 55

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

Answer 55

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

Question 56

What are the exceptions to confidentiality?

Answer 56

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)

Question 57

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

Answer 57

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)

Question 58

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

Answer 58

false - not included since they are in the baby record overall use discretion, meant to be used as a guide

Question 59

Which growth charts should be used in children? a) WHO b) CDC c) neither

Answer 59

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

Question 60

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

Answer 60

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

Question 61

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

Answer 61

d) obese >97th percentile | overweight is 85-97th percentile

Question 62

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

Answer 62

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

Question 63

What age is precocious puberty in girls?

Answer 63

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

Question 64

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

Answer 64

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)

Question 65

Which of the following should be screened for in all female teenagers? a) chlamydia b) gonorrhea c) HIV d) syphillis

Answer 65

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

Question 66

How many healthy Canadian children use CAMs

Answer 66

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

Question 67

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

Answer 67

true - it can increase (modestly) physical activity

Question 68

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

Answer 68

true - certain programs can encourage sexually irresponsible behaviour

Question 69

What is the upper limit of recommended noise level for occupational use? a) 60 dB b) 85dB c) 100 dB d) 120 dB

Answer 69

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

Question 70

How much sleep do teenagers need at night? a) minimum 6 hours b) minimum 7 hours c) minimum 8 hours d) minimum 9 hours

Answer 70

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

Question 71

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

Answer 71

true based on a systematic review

Question 72

Which of the following is more effective in crash prevention? a) driver education b) graduated license programs

Answer 72

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

Question 73

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

Answer 73

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

Question 74

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

Answer 74

true - they do (fair evidence)

Question 75

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

Answer 75

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

Question 76

true or false - swimming lessons prevent drowning

Answer 76

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

Question 77

Which are the two most important strategies to prevent drowning?

Answer 77

1. active supervision | 2. pool fencing

Question 78

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

Answer 78

>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

Question 79

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

Answer 79

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

Question 80

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

Answer 80

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

Question 81

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

Answer 81

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

Question 82

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

Answer 82

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

Question 83

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

Answer 83

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)

Question 84

Which of the following is the most sensitive and specific test for iron deficiency? a) ferritin b) Hg c) none of the above

Answer 84

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

Question 85

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

Answer 85

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

Question 86

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

Answer 86

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)

Question 87

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?

Answer 87

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

Question 88

How many children >13 years old will be immune to varicella despite a negative history? a) 40% b) 60% c) 80% d) 90%

Answer 88

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

Question 89

Who should be screened for TB in Canada?

Answer 89

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

Question 90

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

Answer 90

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

Question 91

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

Answer 91

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)