Cystic Fibrosis, Obesity, and Child Abuse

Question 1

What is cystic fibrosis?

Answer 1

is an inherited, recessive, genetic disorder that affects the exocrine glands (those glands that secrete mucus) due to a genetic defect.

Question 2

How does CF present?

Answer 2

CF usually presents with primary problems in the lungs, sinus cavities, and digestive system

Question 3

What are the early symptoms of CF?

Answer 3

Early symptoms include a dry cough, and an increased respiratory breathing rate

Question 4

What are the later symptoms of CF?

Answer 4

Later symptoms include frequent cough and frequent respiratory infections.

Question 5

What is the incidence of CF?

Answer 5

1/2500 births

Question 6

___% are diagnosed with CF in the first year of life, ____% by age two and ____% by 10 years of age.

Answer 6

60% are diagnosed in the first year of life
75% by age two
90% by 10 years of age.

Question 7

Approximately _____ people in the US are diagnosed with CF

Answer 7

30,000

Question 8

Adults with CF now account for _____%

of CF population

Answer 8

38.7

Question 9

The key to Cystic Fibrosis is …

Answer 9

Clogging of ducts

Question 10

With CF, the affected areas of the body are …

Answer 10

the airways, liver, pancreas, intestine, and

reproductive tract.

Question 11

With CF, Usually, death occurs early; often before age ___-___ (median life expectancy ____ yrs)

Answer 11

30-40

37.5

Question 12

How are airways affected by CF?

Answer 12

Clogging and infection of bronchial passages impede breathing
Infections destroy the lungs
Lung disease accounts for the most deaths from CF

Question 13

How is the liver affected by CF?

Answer 13

Plugging of small bile ducts impedes digestion and disrupts liver function in 5% of pts

Question 14

How is the pancreas affected by CF?

Answer 14

Occlusion of ducts prevents the pancreas from delivering critical digestive enzymes to the bowel in 65% of patients

Diabetes can result as well

Question 15

How is the small intestine impacted by CF?

Answer 15

Obstruction of the gut by thick stool necessitates surgery in about 10% of newborns

Question 16

How is the reproductive tract impacted by CF?

Answer 16

Absence of fine ducts, such as the vas deferans, renders 95% of males infertile. Occasionally, women are made infertile by a dense plug of mucus that blocks sperm from entering the uterus.

Question 17

How is the skin impacted by CF?

Answer 17

malfunctioning of sweat glands causes perspiration to contain excessive salt. Measurement of chloride in sweat is a mainstay of diagnosis.

Question 18

What are the chances of a baby getting CF?

Answer 18

If both parents are carriers;
● A 25% chance that the
child will be born with
cystic fibrosis; 
● A 50% chance that the
child will not have CF, but
will be a carrier; 
● A 25% chance that the
child will not have CF, and
will not be a carrier.

Question 19

Gene responsible for CF identified in1989:

Answer 19

CF Transmembrane Regulator Protein (CFTR).

Question 20

In normal cells, CFTR allows …

Answer 20

the release of Clˉ from the cell.

Question 21

When the Clˉ leaves the cell, an imbalance is created which …

Answer 21

draws water out of the cell through osmosis.

Question 22

Pathophysiology of CF

Answer 22

● Abnormally thick, viscous mucus secretions principally affecting:

◦ BRONCHIAL TUBES
–◦ obstruction, damage to cilia, immobility of mucus blanket

◦ PANCREATIC DUCTS
–◦ digestive enzymes cannot leave the pancreas- malnutrition

◦ SWEAT GLANDS
–◦ salty sweat loss

◦ CARDIOPULMONARY SYSTEM
–◦ nailbed clubbing, airway collapse, etc.

◦ REPRODUCTIVE SYSTEM
–◦ sterility in males, difficulty with conception in females

Question 23

Which lower airway infection is a death sentence for patients with CF?

Answer 23

p. cepacia

Question 24

What red flag occurs when a newborn doesn’t poop?

Answer 24

meconium ileus

Question 25

What are the treatments for CF?

Answer 25

1) Postural drainage⇒ bronchial dilator⇒ gravity drainage, percussive therapy 2) Intermittent positive pressure breathing (IPPB) 3. Self- administered airway clearance techniques (ACTs), Autogenic drainage, active cycle of breathing, ThAIRapy Vest and PEP devices such as the Acapella and the Flutter

Question 26

How does CF impact exercise response?

Answer 26

● Related to severity of lung disease ● Can be affected by nutritional status ● Can be affected by pathophysiology of skeletal muscle tissue

Question 27

True or false: An | inactive lifestyle may partially explain the poorer survival of female patients with CF.

Answer 27

True

Question 28

What are the exercise recommendations for patients with CF?

Answer 28

● Exercise is “self-limiting” ● HR-based: not recommended since pulmonary function may be limiting factor ● Target HR: < desaturation level during exercise (keep above 90%) ● Swimming is highly recommended ● Facilitation of mucus expectoration

Question 29

Long-term survival better in people with CF without | ___________ insufficiency

Answer 29

pancreatic

Question 30

In CF, poorer outcomes with colonization of...

Answer 30

pseudomonas, persistent respiratory problems | and airway hyperactivity

Question 31

The prevalence of obesity was higher among __________ and ________ than among _________.

Answer 31

Hispanics (21.9%) and non-Hispanic blacks (19.5%) than among non-Hispanic whites (14.7%).

Question 32

The prevalence of obesity was lower in ________ than in youth who were ________, ___________ or __________.

Answer 32

non-Hispanic Asian youth (8.6%) than in youth who were non-Hispanic white, non-Hispanic black, or Hispanic.

Question 33

What are three things that increases a child's risk of developing type II diabetes ?

Answer 33

⚫ Overweight and obesity is the most significant risk factor in the development of type 2 diabetes (T2DM) in children. ⚫ Prenatal exposure to maternal type I or II diabetes ⚫ Family history/culture

Question 34

Ages ___-___ are the most important developmental stages for establishing healthy exercise and eating pattern

Answer 34

0-6

Question 35

Parents should make sure that 3-4 year olds should get ______ of “active” play each day

Answer 35

at least one hour

Question 36

How can overweight and obesity be prevented and treated in children?

Answer 36

● Reaching and maintaining an appropriate body weight ● Focus on small but permanent changes in eating rather than a series of short-term changes that can't be sustained. ● Reducing dietary fat is the easiest change. ● Highly restrictive diets that forbid favorite foods are likely to fail and should be limited to patients with severe complications who must lose weight quickly.

Question 37

What is prevention of increased weight gain velocity?

Answer 37

In treating most overweight children, the main emphasis should be to prevent weight gain above what's appropriate for expected increases in height.

Question 38

What are the factors that predict success of maintaining a healthy life style?

Answer 38

◦ frequent intervention visits ◦ including parents in the dietary treatment program ◦ strong social support of dietary intervention from others involved in preparing food ◦ regular exercise prescription including social support

Question 39

A BMI over the ____th percentile has arbitrarily been used to define obesity, even though variations in body size (as well as increases in body fat) increase the BMI.

Answer 39

95th

Question 40

Children and adolescents exhibit a _______ frequency and _______ tidal volume than adults at all intensities of exercise

Answer 40

higher frequency and lower tidal volume

Question 41

Children process _____ air (liters per minute) than adults

Answer 41

Less

Question 42

children process ______ liters/min/kg body weight than adults at submaximal exercise

Answer 42

More

Question 43

At max exercise, children use _______ air (liters/min/kg) as adults

Answer 43

A similar amount

Question 44

True or false: children sweat more than adults

Answer 44

False

Question 45

True or false: children have a higher muscle blood flow than adults

Answer 45

True

Question 46

True or false: Max HR is higher in adults than children and adolescents

Answer 46

Max HR is higher in children and | adolescents than adults

Question 47

_____-_____ beats per min is not extraordinary for children and HR >_____ is not a cause for alarm unless there are other signs of distress or pathology

Answer 47

195-205 beats per min is not extraordinary HR >200 is not a cause for alarm

Question 48

True or false: healthy children can exercise at over 200 for a few minutes without any cause for alarm

Answer 48

True

Question 49

True or false: HR will recover to resting levels over a longer period in children and adolescents

Answer 49

False

Question 50

Relative to body weight, VO2max: Remains unchanged in boys from ___ to ___ yo and then decreases steadily In girls remains unchanged until ___ to ___ yo and then decreases steadily

Answer 50

Boys: 8-16 Girls: 10-12 Because puberty

Question 51

True or false: High temperatures take less of a toll on children than adults

Answer 51

False ◦ Lower SV will necessitate an increased HR ◦ Lower blood pressure will result and blood to the vital organs will be decreased

Question 52

More activity leads to _______ bone volume and mass (mineralization)

Answer 52

Increased

Question 53

True or false: Having high bone density early in life | helps later in life

Answer 53

True

Question 54

True or false: Even before puberty, boys have physical advantages that make them stronger than girls

Answer 54

False: There is little difference in strength between girls and boys before puberty

Question 55

Boys increase muscle mass due to...

Answer 55

Testosterone

Question 56

Girls increase __________ due to estrogen

Answer 56

fat mass

Question 57

What are the precautions for children and adolescents performing resistance training, as per ACSM?

Answer 57

Children and adolescents can participate in resistance training, but there are specific precautions: ``` ◦ Requires close, adult supervision ◦ Adequate warm-up ◦ High reps per set (no less than 6-8) ◦ No more than 2-3x/wk ◦ Emphasis on form ◦ Flexibility exercises ◦ Competitive lifting/body building should never be done ◦ Do not perform isolated eccentric workouts ◦ Maximal lifts are contraindicated ```

Question 58

Mandated reporters are required to report suspected child abuse or maltreatment when they are presented with ...

Answer 58

a reasonable cause to suspect child abuse or maltreatment in a situation where a child, parent, or other person legally responsible for the child is before the mandated reporter when the mandated reporter is acting in his or her official or professional capacity.

Question 59

True or false: Abuse also includes situations where a parent or other person legally responsible knowingly allows someone else to inflict such harm on a child

Answer 59

True

Question 60

What is maltreatment?

Answer 60

A child’s physical, mental or emotional condition has been impaired, or placed in imminent danger of impairment, by the failure of the child's parent or other person legally responsible to exercise a minimum degree of care

Question 61

What are some things that fall under the umbrella of maltreatment?

Answer 61

✶ failing to provide sufficient food, clothing, shelter, education; or ✶ failing to provide proper supervision, guardianship, or medical care (refers to all medical issues, including dental, optometric, or surgical care); or ✶ inflicting excessive corporal punishment, abandoning the child, or misusing alcohol or other drugs to the extent that the child was placed in imminent danger.

Question 62

What are some indicators of maltreatment?

Answer 62

✶ Obvious malnourishment, listlessness, or fatigue; ✶ Stealing or begging for food; ✶ Lack of personal care—poor personal hygiene, torn and/or dirty clothes; ✶ Untreated need for glasses, dental care, or other medical attention; ✶ Frequent absence from or tardiness to school; ✶ Child inappropriately left unattended or without supervision.

Question 63

What are some indicators of physical abuse?

Answer 63

✶ Injuries to the eyes or both sides of the head or body (accidental injuries typically only affect one side of the body); ✶ Destructive, aggressive, or disruptive behavior; ✶ Passive, withdrawn, or emotionless behavior; ✶ Fear of going home or fear of parent(s). ✶ Frequent injuries of any kind (bruises, cuts, and/or burns), especially if the child is unable to provide an adequate explanation of the cause. These mayappear in distinctive patterns such as grab marks, human bite marks, cigarette burns, or impressions of other instruments;

Question 64

What are some indicators of sexual abuse?

Answer 64

✶ Symptoms of sexually transmitted diseases; ✶ Injury to genital area; ✶ Difficulty and/or pain when sitting or walking; ✶ Sexually suggestive, inappropriate, or promiscuous behavior or verbalization; ✶ Expressing age-inappropriate knowledge of sexual relations; ✶ Sexual victimization of other children

Question 65

True or false: Anyone who is mandated to report suspected child abuse or maltreatment—and fails to do so could be charged with a CLASS A MISDEMEANOR and subject to CRIMINAL PENALTIES. Further, mandated reporters can be SUED in a civil court for monetary damages for any harm caused by the mandated reporter‘s failure to make a report to the SCR.

Answer 65

TRUE