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Flashcards in PPS Policy Statements Deck (84):
1

What are the three types of cloning technologies?

What is the stand of the PPS on this matter?

gene cloning, therapeutic cloning, reproductive cloning

The PPS supports the worldwide ban on human reproductive cloning.

gene cloning - also known as recombinant DNA technology
therapeutic cloning - sourcing stem cells from an embryo, embryo dies in the extraction process
reproductive cloning - embryo is allowed to mature, producing a clone of the donor animal, same chromosomal DNA as the donor, but mitochondrial DNA of the enucleated egg

in therapeutic and reproductive cloning, the DNA of an embryo is removed and replaced by DNA from an adult animal

2

BMI between the 85th and 95th percentile for age and gender

At risk for obesity

3

BMI at or above the 95th percentile for age and gender

Overweight

* Weight for length is usually used in the under 2 year age group

4

What is the minimum employable age in the Philippines?

15 yrs old

Children between 15 and 18 years old may be employed in undertakings not hazardous or deleterious in nature

A child below 15 years old is not permitted to work in any public or private establishment, with two exceptions:
1) child works directly under the sole responsibility of his guardian/parent/legal guardian; health, morals, and devt are not endangered
2) child's employment or participation in public entertainment or information through cinema, theater, radio or television is essential
2)

5

In cases where a child is allowed to work below 15 yrs old, what is the allowable work hours per day and work days per week?

not more than 4 hours per day, 5 days per week

6

What is the allowable work hours per day and per week in children 15-18 yrs of age, provided that they work in non-hazardous circumstances?

not more than 8 hours per day and not more than 40 hours per week

- working children are to have, at any time, access to primary and secondary education and training (formal or non-formal)

7

What is Republic Act 9231?

Anti-Child Labor Law

- The Act provides for the elimination of the worst forms of child labor and affords stronger protection for the working child

8

What is the maximum level of use of caffeine in children?

200 ppm

9

Among the following beverages, which has the highest caffeine content?

a. Coke
b. 7-Up
c. Mountain Dew
d. Pepsi

c. Mountain Dew

a. Coke (regular) - 34 mg
b. 7-Up - 0 mg
c. Mountain Dew - 55 mg
d. Pepsi - 37 mg

10

Exceptions to pre-operative risk assessment (2)

(1) Healthy patients requiring nerve blocks, local or topical anesthesia and/or no more than 50% nitrogen oxide, oxygen and no other sedative or analgesic agents, and
(2) Patients receiving sedation analgesia or conscious sedation.

11

What is the greatest risk in doing surgical procedures among the pediatric population?

a. cardiovascular
b. pulmonary and airway

b. pulmonary and airway

However, cardiac conditions together with coagulopathy, anemia, pregnancy and reactions to anesthesia may increase the risk in the pediatric population and must also be given due consideration.

12

Laboratory examinations to be done routinely when obtaining pre – operative clearance in the pediatric population

1) complete blood count with hematocrit, differential count and quantified platelet count
2) chest X – ray (PA-Lateral)

- Once the patient has been evaluated by a pediatrician, it is the pediatrician's prerogative whether to order additional laboratory examinations or to refer the patient to a corresponding specialist

13

Important components of pediatric PE for sports clearance (4)

1. Precordial auscultation in both the supine and standing positions to identify, in particular, heart murmurs consistent with dynamic left ventricular outflow obstruction;
2. Assessment of the femoral artery pulses to exclude coarctation of the aorta;
3. Recognition of the physical stigmata of Marfan syndrome; and 4. Brachial blood pressure measurement in the sitting position

14

What are the contraindications to breastfeeding?

What are the relative contraindications to breastfeeding (stated in PPS guidelines)?

1. galactosemia in the infant
2. maternal use of illegal drugs, anti-neoplastic agents and radiopharmaceuticals

Relative contraindications:
1. Active tuberculosis infection
2. Maternal HIV infection

- breastfeeding is allowed after observed treatment with anti-Koch's therapy for 2 weeks. During the two weeks of treatment, breast milk can still be given to the infant by cup or dropper. The breast milk should be expressed in a strictly aseptic manner and given to the infant by a caregiver other than the mother
- HIV-positive mothers may still opt to give their infants expressed and heat-treated breast milk

15

Republic Act (RA) No. 7600 is known as

“The Rooming-In and Breastfeeding Act of 1992”

16

Rare disorders not prioritized by pharmaceutical industry and researchers in the development of new treatment and research due to perceived low return of investment and low utilization due to its rarity

Orphan disorders

WHO defines orphan disorders as conditions that affect less than 1000 people per million.

In the Philippines: disorders affecting 1 in every 20,000 individuals

17

What is the recommended backpack weight for school children

The weight must not exceed more than 10% of the child's body weight

18

What is the recommended daily intake of folic acid for women of childbearing age?

0.4 mg (400ug)

- Although adequate folate consumption from food was shown to have a protective effect against NTD-affected pregnancies, it should be coupled with intake of folic acid supplements
- Studies reveal that folic acid supplementation prior to and in the beginning of pregnancy dramatically reduce the risk of having an NTD-affected pregnancy.

19

What is the 6th most common birth defect in the Philippines?

Neural tube defects (anencephaly and other similar malformations)

20

What is the recommended daily intake of folic acid for women with NTD-affected pregnancies who wish to get pregnant?

4 mg (4000 µg) one month prior to getting pregnant until the first three months of pregnancy

For those who are planning another pregnancy, consultation with a health provider is a must because daily folic acid consumption should be increased to 4 mg (4000 µg) one month prior to getting pregnant until the first three months of pregnancy.

Daily intake of 0.4 mg (400 µg) of folic acid is recommended when these women have no intention of getting pregnant.

21

Sucking activity in children is a commonly observed behavior in which age group?

0-18 mos

22

Which material used for pacifiers is more likely to have a higher carriage of C. albicans?

a. rubber
b. silicone
c. latex

c. Latex

Pacifiers made of latex were more likely to have higher carriage of C. albicans compared to those made of silicone.

23

Should parents opt to use pacifiers, when should it be started and discontinued?

Start pacifier use only after breastfeeding has been well established. Discontinue use before the permanent incisors erupt, ideally before 4 yrs of age.

24

According to the Philippine Pediatric Dental Society, prolonged pacifier use may promote what kind of dental anomaly?

malocclusion and open bite

- use orthodontic pacifiers at the very least if parents decide to use one

25

At what age can a child be allowed to sit in the front seat of a motor vehicle?

>6 yrs old

- below 6 yrs old, children should be seated at the back

26

When should specialized child seats be used before being able to use the built-in seatbelts in motor vehicles? (maximum weight and age)

use specialized child seats for children weighing up to 60 lbs or up to 8 yrs old

use of built in car seatbelts is mandated for children older than 8 yrs old

27

What is considered the maximum safe level of noise exposure?

less than 85 dB

- this is the maximum set point at which adverse effects can result
- auditory effects: hearing impairment, acoustic trauma
- non-auditory effects: physiological, stress, behavioral

28

What is the safety requirement on toys producing sounds as recommended by the American Society for Testing and Materials?

Instantaneous sound produced by the toy should not exceed 138 dBA at any point 25 cm from the surface of the toys

29

In listening to a portable music player, what is the recommended maximum listening time that would prevent noise-induced hearing loss?

No more than 60% of the maximum volume for only 30 minutes in a day

- there are no time limits to the use of a portable music player at 0-50% of the maximum volume

30

What are the disorders included in newborn screening?

phenylketonuria (PKU)
congenital adrenal hyperplasia (CAH)
congenital hypothyroidism (CH)
galactosemia (GAL)
glucose-6-phosphate dehydrogenase deficiency (G6PD)

31

What is the WHO recommended exposure limit for continuous and impulsive noise in the workplace?

continuous noise: 80-85 dB for 8hrs max
impulsive noise: 140 dB at any one exposure

continuous noise- sound level peaks are 1 second apart or less
impulsive noise - steep rise of sound level to a high peak followed by a rapid decay

32

A precursor to noise-induced hearing loss, defined by WHO as a change in hearing threshold of an average of 10 dB or more of 2000 to 4000 Hz in either ear

Transient Threshold Shifts (TTS)

- initial exposure to excessive noise results in TTS, which eventually leads to hearing loss with chronic exposure

33

What type of ear plug has the largest sound attenuation?

foam type ear plug

34

At work, what is the permissible noise level set by the DOH, Occupational Health Division?

90 dB for 8 hrs

- this is poorly implemented in our country

35

What is the maximum recommended DNL (day-night sound level) by the US Environmental Protection Agency?

55 dB (day) - 45 dB (night)

in the hospital, 45 dB (day) - 35 dB (night)

36

What are the leading causes of blindness in the Philippines?

vitamin A deficiency
malnutrition
measles
premature birth

37

When is the earliest possible age for visual acuity measurement?

3 yrs old

38

What are the top mechanisms of burn injury in the Philippines?

Scalding
Naked flame
Electrical injuries
Chemical burns

- Peak times of injury are at 10AM-12PM and at 4PM-6PM, and coincide with food preparation.
- risk factors: absence of water supply, low salary, and crowding

39

A precursor to noise-induced hearing loss, defined by WHO as a change in hearing threshold of an average of 10 dB or more of 2000 to 4000 Hz in either ear

Transient Threshold Shifts (TTS)

- initial exposure to excessive noise results in TTS, which eventually leads to hearing loss with chronic exposure

40

What type of ear plug has the largest sound attenuation?

foam type ear plug

41

At work, what is the permissible noise level set by the DOH, Occupational Health Division?

90 dB for 8 hrs

- this is poorly implemented in our country

42

What is the maximum recommended DNL (day-night sound level) by the US Environmental Protection Agency?

55 dB (day) - 45 dB (night)

in the hospital, 45 dB (day) - 35 dB (night)

43

What are the leading causes of blindness in the Philippines?

vitamin A deficiency
malnutrition
measles
premature birth

44

When is the earliest possible age for visual acuity measurement?

3 yrs old

45

What are the top mechanisms of burn injury in the Philippines?

Scalding
Naked flame
Electrical injuries
Chemical burns

- Peak times of injury are at 10AM-12PM and at 4PM-6PM, and coincide with food preparation.
- risk factors: absence of water supply, low salary, and crowding

46

A precursor to noise-induced hearing loss, defined by WHO as a change in hearing threshold of an average of 10 dB or more of 2000 to 4000 Hz in either ear

Transient Threshold Shifts (TTS)

- initial exposure to excessive noise results in TTS, which eventually leads to hearing loss with chronic exposure

47

What type of ear plug has the largest sound attenuation?

foam type ear plug

48

At work, what is the permissible noise level set by the DOH, Occupational Health Division?

90 dB for 8 hrs

- this is poorly implemented in our country

49

What is the maximum recommended DNL (day-night sound level) by the US Environmental Protection Agency?

55 dB (day) - 45 dB (night)

in the hospital, 45 dB (day) - 35 dB (night)

50

What are the leading causes of blindness in the Philippines?

vitamin A deficiency
malnutrition
measles
premature birth

51

When is the earliest possible age for visual acuity measurement?

3 yrs old

52

What are the top mechanisms of burn injury in the Philippines?

Scalding
Naked flame
Electrical injuries
Chemical burns

- Peak times of injury are at 10AM-12PM and at 4PM-6PM, and coincide with food preparation.
- risk factors: absence of water supply, low salary, and crowding

53

An 18 mo old child refuses to lie down for his recumbent length to be taken. Standing height measures 70 cm. What is the corrected length of the patient?

70.7 cm

- for children below 2 yo, recumbent length must be taken (RL)
- standing height (SH) = RL - 0.7 cm
- hence, in this patient, whose height should be measured in the recumbent position, RL = SH + 0.7 = 70+0.7 = 70.7 cm
- if a child is more thn 2 yo and the SH cannot be taken, subtract 0.7 from RL to convert it to height

54

Blood pressure measurement is recommended for children starting 3 y/o. Based on the patient's age, height and gender, BP percentile can be determined. What are the percentiles that define patients who are

a. normotensive
b. prehypertensive
c. hypertensive

a. normotensive: =p95 on 3 or more occasions

55

When should Newborn Screening be performed?

a. within 24 hrs
b. after 24 hrs
c. after 72 hrs

NBS should be performed within 24-72 hrs
(after 24 hrs but not later than 3 days from birth)
- exemptions to 3-day rule: if placed in ICU, but NBS must be done by the 7th DOL

56

What is the most common presenting signs of retinoblastoma?

strabismus and leukocoria

-routine eye examination of infants and young children is recommended for early detection of strabismus and leukocoria

57

What is the recommended regimen for iron supplementation for the following groups?

a. LBW
b. Infants (6-11 mos)
c. Children (1-5 yo)
d. Adolescent girls (10-19 yo)

a. LBW
drops 15mg/0.6 ml, 0.3 ml OD at 2-6 mos old

b. Infants (6-11 mos)
drops 15mg/0.6 ml, 0.6 ml OD x 3 mos

c. Children (1-5 yo)

syrup 30 mg/5 ml, 5 ml OD for 3 mos or 5 ml once a week for 6 mos, supervised

d. Adolescent girls (10-19 yo)
tablet 60 mg elemental Fe + 400 mcg folic acid, 1 tab OD

58

The most common intraocular tumor in childhood and the 3rd most common malignancy in children below 16 yrs old

retinoblastoma

- also the most highly curable pediatric solid tumor

59

Most common presenting sign of retinoblastoma

leukocoria

- leukocoria is examined through the Bruckner test (red reflex)
-

60

What are the common pathogens of pneumonia in the malnourished child?

Streptococcus pneumoniae
Haemolhilus influenzae

M. tuberculosis and gram-neg enteric bacilli should be considered in non-responsive pxs

61

What are the usual pathogens causing pneumonia in children with concomitant TB?

Consider: S. pneumoniae and H. influenzae

If non-responsive, consider: M. tuberculosis and gram-negative enteric bacilli

If with extensive pulmonary parenchymal damage, consider: anaerobes or S. aureus

62

In patients with congenital heart disease, what are the most common pathogens that cause pneumonia?

RSV and influenza

63

In patients with asthma, what is the nost common pathogen that causes pneumonia?

Chlamydia pneumoniae

- associated with persistent type of asthma
- 55% are colonized with atypical organisms in their airways

64

In children, what are the most common causes of chronic cough?

asthma, postnasal drip syndrome, GERD

65

In patients with chronic cough and expiratory stridor, what should be the diagnostic modality of choice?

flexible bronchoscopy

- consider tracheomalacia or vascular rings

66

A congenital condition characterized by floppiness or weakness of the wall of the airway which presents as expiratory stridor

tracheomalacia

- no specific treatment necessary in majority of cases
- most follow a benign course

67

What are the two most common types of complete vascular rings?

Double aortic arch
Right aortic arch with left ligamentum arteriosum

- common symptoms: stridor, cyanosis, respiratory distress,apnea, and/or characteristic high-pitched brassy cough

68

In a patient suspected of having a vascular ring, what is the best imaging modality?

barium esophagogram

- the most important study in patients with suspected vascular rings
- diagnostic in majority of cases
- surgical division of symptomatic vascular rings is the only form of therapy

69

What is the single most common cause of chronic cough in adults and children?

postnasal drip syndrome

70

What are the common pathogens causing sinusitis?

Streptococcus pneumoniae
Haemophilus influenzae
Moraxella catarrhalis

- Tx: amoxicillin or 2nd gen cephalosporins or a macrolide
published local data suggest low resistance of the ff drugs:
- S. pneumoniae: penicillin, co-trimoxazole, chloramohenicol
- H. influenzae: ampicillin, cotrimoxazole, chloramphenicol

71

What is the case definition for dengue without warning signs?

1. PROBABLE DENGUE
- epidemiology: lives, travels to dengue endemic areas with FEVER plus
- clinical signs: any two of the ff: headache, body malaise, myalgia, arthralgia, retroorbital pain, anorexia, nausea, vomiting, diarrhea, flushed skin, rash (petechiae, Hermann's sign), positive tourniquet test
- AND: laboratory test: at least CBC (leukopenia with or without thrombocytopenia) and/or dengue NS1 antigen test or dengue IgM antibody test

2. CONFIRMED DENGUE
- viral culture isolation
- PCR

72

What is the case definition for dengue WITH warning signs?


1. epidemiology: lives, travels to dengue endemic areas with fever
2. clinical signs: any two
- abdominal pain
- persistent vomiting
- clinical signs of fluid accumulation
- mucosal bleeding
- lethargy, restlessness
- liver enlargement
- decreased or NO urine output within 6 hrs
- Lab: increased Hct and/or decreasing platelet count

CONFIRMED DENGUE
- viral culture isolation or PCR

73

What is the case definition for SEVERE dengue?

Lives in or travels to a dengue endemic area with fever of 2-7 days and any of the clinical manifestations of dengue with or without warning signs, plus any of the following:
1. severe plasma leakage,cleading to: shock, fluid accumulation with respiratory distress
2. severe bleeding
3. severe organ impairment
- liver: AST/ALT >= 1000
- CNS: seizures, impaired consciousness
- heart: myocarditis
- kidneys: renal failure

74

What is the recommended ORS rehydration in patients with Dengue without warning signs who are NOT admitted?

using reduced osmolarity ORS with Na 50-75 mmol/L:

Body weight (kg) / ORS to be given (ml/kg/day)

3-10 / 100
10-20 / 75
20-30 / 50-60
30-60 / 40-50

do not give sports drinks with Na < 20 meqs

75

What are the ABCS in fluid resuscitation of a patient with dengue who is in profound shock?

Acidosis, bleeding, calcium, sugar

- ABG: acidosis indicates prolonged shock
- CBC: if Hct decreases or is not rising, do crossmatch for possble BT
- serum Ca: hypocalcemia is found in almost all cases of DHF, but asymptomatic
- blood sugar

76

What is the maximum maintenance fluid requirement per day in patients with dengue to avoid fluid overload?

fluids should not exceed 3 L/day

77

What is the most commonly ingested poison in the pediatric age group?

household cleaning agents
(chlorine, decalcifier, hydrochloric acid, sodium hypochlorite, phenol)

- next most common: hydrocarbons
(kerosene, diesel oil, lighter fluid, paint thinner)
- third most common: jathropa seeds

78

What is the toxic dose of iron ingestion?

10-20 mg/kg

- 5 stages of iron toxicity
Stage 1. GI symptoms: nausea, ab pain, vomiting, diarrhea, hematemesis, melena, hematochezia
Stage 2. Latent stage - 6-24h after resolution of GI sxs before overt toxicity
Stage 3. Shock stage
Stage 4. Hepatic failure 2-3 days after ingestion
Stage 5. Gastric outlet obstruction sec to strictures and scarring, 2-3 wks after ingestion (rarely occurs)

79

What are the signs and symptoms of watusi poisoning?

Burns, burning pain in the throat, garlic odor from breath, nausea, vomiting, diarrhea, diarrhea, abdominal pain, and shock

- hypocalcemia, hypoprothrombinemia, metabolic acidosis, mucosal injury of the esophagus
- pxs who ingested watusi are given egg whites to prevent further absorption

80

What is the first aid treatment for watusi ingestion?

give egg whites, 4-6 for children, 6-8 for adults

81

What is the CDC definition of elevated blood lead levels?

>= 10 mg/dL

- found in one venous blood sample or two capillary blood specimens drawn within 12 wks of each other

82

What is the most life-threatening adverse effect of lead intoxication?

lead encephalopathy

- at >70 mg/dL, px may present initially as lethargy, abdominal cramps, anorexia, and irritability
- after a few weeks, vomiting, clumsiness, ataxia, hyperirritability and stupor to coma and seizures
- at low levels, lead decreases IQ levels, delayed growth and pubertal devt in girls

83

What are the ABCS in fluid resuscitation of a patient with dengue who is in profound shock?

Acidosis, bleeding, calcium, sugar

- ABG: acidosis indicates prolonged shock
- CBC: if Hct decreases or is not rising, do crossmatch for possble BT
- serum Ca: hypocalcemia is found in almost all cases of DHF, but asymptomatic
- blood sugar

84

What is the maximum maintenance fluid requirement per day in patients with dengue to avoid fluid overload?

fluids should not exceed 3 L/day