Ethics Flashcards
(37 cards)
3 things to do if asked to provide evidence in court?
Contact CMPA for medical legal advice
Contact patient to get expressed consent to provide witness
Or need subpoena if no consent provided
Minimum age for power mobility?
18 - 24 months if no cognitive or sensory co-occurring disorders
4 ethical responsibilities of physicians
Autonomy
Beneficence
Non-maleficence
Justice
3 ophtho causes of blindness
Glaucoma
Retinopathy of prematurity
Cataracts
reasons while braille might be harder than using large letters
-parents may not know braille
-difficult to access teachers who are able to teach braille
-not enough time in school to teach braille in addition to other topics
-if associated motor impairments - potentially braille might be harder?
-or decreased sensory input from digits
Name 6 signs of burnout or substance use in colleges
Late to appointments; increased absences; unknown whereabouts
Unusual rounding times, either very early or very late
Increase in patient complaints
Increased secrecy
Decrease in quality of care; careless medical decisions
Incorrect charting or writing of prescriptions
Decrease in productivity or efficiency
Increased conflicts with colleagues
Increased irritability and aggression
Smell of alcohol; overt intoxication; needle marks
Erratic job history
4 predictors of poor outcomes after cochlear implants
CMV infection
Hypoplastic inner ear malformations
Cochlear nerve deficiency
Poor or absent e-ABRs in auditory neuropathy spectrum disorder
4 factors that predict better outcome after cochlear implants
Bilateral implantation for bilateral HL
Better preop hearing performance
Quality parent-child interactions
Favourable social determinants
Few comorbidities (ex. w/o DD)
Etiology (see right)
Implanting at earlier age
Post-lingually acquired deafness
Hearing hour percentage (i.e. % of day implant is active)
Post-operative auditory verbal habilitation
5 causes of abnormal hearing with normal hearing at birth?
Genetic
Syndromic versus non-syndromic
Bacterial meningitis
The most common cause of postnatally acquired (i.e. versus genetic) deafness in childhood
Ototoxic drugs
Chemotherapeutics
Aminoglycosides
Trauma
Temporal bone
Tumours
Vestibular schwannoma
Hyperbilirubinemia
Noise exposure
Congenital CMV (delayed onset)
3 indications for cochlear implants
bilateral > unilateral
Severe to profound
family readiness
> 12 months
No or limited benefit of other amplification
spoken language primary mode of communication
Risk of hearing loss in patients in long NICU stay
younger gestational age
Ototoxic medications
HIE
hyperbilirubinemia
meningitis
intracranial hemorrhage
Work up for SNHL
(history, development, family history, immune disorders)
Genetics
MRI
CMV serology (if in the first 3 weeks/neonatal period)
Vestibular assessment
Opthalmologic assessment
Urinalisys for microscopic hematuria (r/o Alport Syndrome)
Secondary level
- serology for congenital infections
- renal ultrasound
- metabolic screen
- hematologic biochemical studies
4 effects of visual disorder on develop
Social skills (shared attention, non-verbal, eye contact)
Gross motor delays
Fine motor delays
Speech and language delay - prolonged echolalia, delayed recognition of objects
Impacts on ADLs
Abnormal behaviors - visual inspection, stereotypic movements
define autonomy, justice, non-maleficence, beneficence
Beneficence: Doing what is good or what is in the best interest of the patient.
Justice: The equitable or fair distribution of health resources
Non-maleficence: The moral obligation to do no harm to the patient.
Autonomy: The right of competent patients to make decisions about their own medical care
name the patient safety outcome that medication safety and three steps of reconciliation
Non-maleficence
Review medication / medication history
Reconcile
Document changes to medications
Refusal of immigration. 3 advocacy steps
Connect with SW
Write an advocacy letter that demonstrates that the child does not have “excess medical needs” if able to do that
Connect with immigration lawyer
3 risk for microarray or genetic testing
VUS outcome
Incidental finding
psychosocial risks
risk of non-paternity if testing parents
4 steps in delivering bad news
SPIKES
Prepare the setting - right people and place
Perceptions - patients perspectives
invitation - to share and discuss topic
Knowledge - sharing
Emotions - empathize and acknowledge
Summary - summary and next steps
SNHL test to identify
Auditory brain stem response (ABR)
vs Otoacoustic emissions - is for conductive
name the diagnosis
1) normal L ear hearing
2) SNHL <15 dB difference between air and bone and below 15 dB loss
3) conductive hearing loss
> = bone
x = air conduction
Long-term outcomes of severe untreated hearing loss
Academic under achievement
reduced employment
Higher emotional difficulties
social challenges or maladjustment
Delayed speech and language
Difficulty wiht complex motor skills
3 most common syndromes associated with hearing impairment
Usher syndrome (AR)
Waardenburg syndrome (AD)
Pendred syndrome
DiGeorge
5 clinic eye exam findings warrant opthal referral
misalignment beyond 4 months (or constant at any age)
absence of social smile or eye contact by 3 months
acuity <20/50, or 2 lines or greater between eyes
Aniscoria
Leukocoria or absent or asymmetric red reflex
horners (ptosis, smaller pupil) - r/o neuroblastoma
Common visual conditions in children with disabilities (8)
Strabismus
Myopia, hyperopia
cortical visual impairment
cataracts
ROP
nystagmus
optic nerve hypoplasia
coloboma
